Text

Causes and Solutions for Pending Cases of Outpatient Claims at RS X Bukittinggi

---

Pending claims have an impact on the delay in payment of medical
services which has an impact on the performance of hospital employees,
thus affecting the quality of hospital services. The purpose of this study
was to determine the causes and solutions to cases of delayed outpatient
claims. The research design used was qualitative descriptive research in
the form of a review of delayed outpatient claim documents and in-depth
interviews. The study was conducted in February-September 2023. The
population of this study was cases of delayed claims in 2023 totaling
2,627 cases. The sample in the study used the Slovin formula, obtaining
a sample of 91 delayed outpatient claim documents. The sampling
technique was Total Sampling. The causes of late inpatient claims are
errors in the completeness of claim submission documents, errors in
determining primary and secondary diagnoses, errors in diagnosis codes
and medical actions, unclear writing on the CPPT, incomplete medical
resumes, confirmation of supporting evidence in determining primary
and secondary diagnoses, confirmation of diagnosis determination for
extraordinary cases that occur due to indications determined by the
doctor after the results of further examinations, provisions in determining
the category of care class, compliance with related provisions. Problems
from the BPJS Verifier side, there are complete claim submission
documents, but they are stated as incomplete, many cases are categorized
as pending, many pending in the form of confirmations and questions.
The solution for BPJS is to implement regulations by inviting all parties
including doctor registration, coders, doctors and other users and to
socialize new regulations to all stakeholders and users. Determination of
the pending category is based on cases that have been analyzed, because
if pending appears due to cases with a large number, there is no error in
submitting claims. The solution for medical records officers and coders
to understand BPJS claim regulations, submit complete claim
documents, pay attention to clinical codification rules in code
enforcement. Communicate effectively with health workers involved.

---

Ketersediaan

Jurnal007Bid

610.5 Yas c

Tersedia

Informasi Detail

Judul Seri

-

No. Panggil

610.5 Yas c

Penerbit

Bukittinggi : LP2M Universitas Prima Nusantara Bukittinggi., 2024

Deskripsi Fisik

VOLUME 15 NOMOR 3 (2024) 1 - 9

Bahasa

English

ISBN/ISSN

2657-1366

Klasifikasi

610.5 Yas c

Tipe Isi

text

Tipe Media

-

Tipe Pembawa

-

Edisi

-

Subjek

Pending Claim
Casemix
Medical Record

Info Detail Spesifik

JURNAL KESEHATAN – VOLUME 15 NOMOR 3 (2024) 1 - 9

Pernyataan Tanggungjawab

-

Versi lain/terkait

Lampiran Berkas

Komentar

---

Anda harus masuk sebelum memberikan komentar