The increase of Covid-19 cases that occurred in Indonesia affected the financial system in healthcare facilities. One of the policies resulting from the increase of Covid-19 cases is that the Ministry of Health issued technical instructions for reimbursement of health service claims for hospitals that provide Covid-19 services. In the implementation of these rules, there are obstacles so that the claims submitted are delayed or not approved. The purpose of this study is to analyze Covid-19 claims approval in terms of input, process, and output components. The research method is cross-sectional with a quantitative descriptive approach. The research was conducted at Siloam Sentosa Hospital Bekasi by reviewing Covid-19 claims with data collection method was done using the document review. The instrument used is a document review sheet to identify policies and describe the approval of claims. The population in this study were all Covid-19 claims in January-February 2021. The sample was taken using a saturated sample with a total of 108 claims. The applications used for the claim process are INA-CBG and E-claims. In the implementation of claim submission, the hospital adopted the technical instruction for claim reimbursement issued by the Ministry of Health and has implemented it. The results of the study show that 63% of approved claims. The cause of the claim not being approved occurred in the process component where the difference of understanding from the coder so that it was not correct in coding, completeness of claim documents, and inconsistency in filling out medical records.
The COVID-19 pandemic is an issue that is being faced by Indonesia and even most countries in the world. The impact due to the COVID-19 pandemic is disruption of hospital with cash flow. It was caused by the delay in hospital payment of claims which are not approved by Badan Penyelenggara Jaminan Sosial (BPJS Kesehatan). Siloam Sentosa Hospital Bekasi provides services for COVID-19 patients. However, out 81 claims of COVID-19 patients in August-October 2020, there were 65 claims (80.25%) not approved by BPJS Kesehatan. The purpose of this study was to analyze the factors that affect the approval claims among patients with COVID-19 at Siloam Sentosa Hospital Bekasi. This type of research was descriptive analysis with a quantitative approach. The research population was 108 claims and the sample used the total population. A Logistic regression test was used to analyze the data. The results of the study explained the completeness of claims, the quality of the medical resume, the completeness of filling out the epidemiological investigation form, and the quality of clinical coding that affected the approval claims. The study showed 21.5% of other factors that are not examined can affect the approval claims. Socialization of policies related to payment of claims to hospitals as well as monitor and evaluate from both hospitals and BPJS Kesehatan need to be improved to prevent claims that are not approved.
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