Causes of Dispute for COVID-19 Outpatient and Inpatient Claims at the Muhammadiyah University General Hospital of Malang

Abstract

Muhammadiyah University General Hospital of Malang is a COVID-19 referral hospital for Malang. Between April 2020 and June 2021, the hospital submitted 62 outpatient and 1364 inpatient cases for COVID-19 claims to the Ministry of Health of the Republic of Indonesia. The percentage of outpatient dispute claims was 25% and of inpatient dispute claims was 39%. These disputed claims disturbed the cash flow of the health facilities. The aim of our study was to describe the causes of outpatient and inpatient COVID-19 dispute claims. Our methodology was descriptive, and the secondary data were taken from claim submission documents. There were ten criteria that caused dispute claims based on KMK Number HK. 01.07/MENKES/4718/2021. This was related to administrative and medical issues. The most common cause of inpatient dispute claims (35%) was that the criteria for discharge from the hospital were not in accordance with the guarantee limit. Additionally, the most common cause of outpatient dispute claims (60%) was the management of isolation that was not related to the guidelines for management and prevention of COVID-19.
 Keywords: claim dispute criteria, hospital, COVID-19