ABSTRAKTesis ini membahas kelengkapan resume medis dan ketepatan koding diagnosis
dalam potensi risiko klaim BPJS di Unit Rawat Inap RSUD Cempaka Putih Tahun
2016. Penelitian menggunakan pendekatan kuantitatif dan kualitatif dengan desain
studi cross sectional. Hasil penelitian ditemukan ketidaklengkapan pengisian
resume medis pada variabel diagnosis sekunder 46%, variabel tanda tangan dokter
penanggung jawab layanan 10,5%, variabel pemeriksaan penunjang 1,6 %.
Ketidaktepatan koding diagnosis pada diagnosis utama 28,2%, diagnosis sekunder
6,4% dan prosedur 6%. Didapatkan risiko klaim tertunda akibat ketidaklengkapan
resume medis sebesar Rp. 159.580.200,-, dan didapatkan selisih klaim akibat
ketidaktepatan koding diagnosis sebesar Rp. 7.062.100,- pada bulan November
dan Rp. 4.821.400,- di bulan Desember.
Hasil penelitian menyarankan agar dilakukan sosialisasi Standar Prosedur
Operasional (SPO), pelatihan koding, pemberlakuan reward dan punishment,
audit koding, pembentukan Tim Koding, dan evaluasi secara berkesinambungan
oleh manajemen.
ABSTRACTThis research discussed about medical resume completeness and the accuracy of
coding diagnoses against potential risks of BPJS claims at Inpatient Units of
RSUD Cempaka Putih in 2016. This research used mix method approach with
cross sectional design. This research found that there is still incompleteness in
filling the medical record for secondary diagnostic variables 46%, the signature of
in charge physician variable 10,5%, and supporting examination variable 1,6 %.
Inaccuracy of coding diagnoses on primary diagnostic 28,2%, secondary
diagnostic 6,4% and procedur 6%. The risk of claims is delayed due to the
incompleteness of medical resume amounting to Rp. 159.580.200,- ,and obtained
the difference in claims due to inaccuracy of Rp. 7.062.100,- in November and
Rp. 4.821.400,- in December.
The results suggested that socialization of standar operational procedur,coding
practice, reward dan punishment implementation, coding audit, coding team
formulation, and continous evaluation by management.
T47707-Wida Guslianti.pdf :: Unduh