Analysis of Medical Record Completeness Factors on The Realization of Claims of COVID 19 Inpatients in Rsud Dr Chasbullah Abdulmadjid Kota Bekasi

Said, Maryam; Windiyaningsih, Cicilia; Andarusito, Nurcahyo; Saidi, Kusnanto

doi:10.33425/2689-1069.1021

Cited by 1 publication

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“…In order for the completeness of the medical record and the success of the claim, the Doctor in Charge of Services must adhere to patient handling guidelines or SOPs. (9,11) In overcoming problems at Hospital X, it is necessary to monitor and always confirm with the doctor in charge of the patient before the claim file is submitted.…”

Section: Comorbid Diagnoses Are Not Following the Provisionsmentioning

confidence: 99%

Dispute Analysis of Claims for Patients With Covid-19: A Case Study at Hospital X Class B in Bantul Regency

Putri

Hafidz²,

Hendrartini³

2023

J INDO HEALTH POLICY ADM

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The Indonesian Government established referral hospitals for COVID-19 as an effort in combating the pandemic. Referral hospitals for COVID-19 submit their services’ claims to the Ministry of Health. Hospital X in Bantul experienced challenges in submitting COVID-19 claims and underwent claim disputes which caused delays in payment process. This research aimed to explore the factors that led to the disputes over the COVID-19 claims. This descriptive research was conducted with a qualitative approach, using in-depth interviews and observations. The additional descriptive analysis used secondary data COVID-19 claim dispute file reports from 2020. The results showed that the highest criteria of disputed claims at Hospital X were the criteria for non-compliant guaranteed participants, incomplete claim files, non-compliant comorbid diagnoses, and identities that did not comply with the provisions. The causes of the disputes over claims for patients with COVID-19 included inaccurate history taking, differences in regulation perceptions between the provider and payer, PCR results were not provided, and doctors had a lack of understanding regarding the technical guidelines for COVID-19 claims. In addition, there were technical problems faced by the hospital during the process of submitting claims, including regulations were changed frequently, errors in applications, incomplete medical resumes, and unreadable doctors’ writings. Disputed claims did not affect the hospital cash flow, yet delayed the payment process to health workers, which might harm the quality of services.

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Section: Comorbid Diagnoses Are Not Following the Provisionsmentioning

confidence: 99%