ABSTRAK Tesis ini membahas kelengkapan resume medis dan ketepatan koding diagnosisdalam potensi risiko klaim BPJS di Unit Rawat Inap RSUD Cempaka Putih Tahun2016. Penelitian menggunakan pendekatan kuantitatif dan kualitatif dengan desainstudi cross sectional. Hasil penelitian ditemukan ketidaklengkapan pengisianresume medis pada variabel diagnosis sekunder 46%, variabel tanda tangan dokterpenanggung jawab layanan 10,5%, variabel pemeriksaan penunjang 1,6 %.Ketidaktepatan koding diagnosis pada diagnosis utama 28,2%, diagnosis sekunder6,4% dan prosedur 6%. Didapatkan risiko klaim tertunda akibat ketidaklengkapanresume medis sebesar Rp. 159.580.200,-, dan didapatkan selisih klaim akibatketidaktepatan koding diagnosis sebesar Rp. 7.062.100,- pada bulan Novemberdan Rp. 4.821.400,- di bulan Desember.Hasil penelitian menyarankan agar dilakukan sosialisasi Standar ProsedurOperasional (SPO), pelatihan koding, pemberlakuan reward dan punishment,audit koding, pembentukan Tim Koding, dan evaluasi secara berkesinambunganoleh manajemen. ABSTRACT This research discussed about medical resume completeness and the accuracy ofcoding diagnoses against potential risks of BPJS claims at Inpatient Units ofRSUD Cempaka Putih in 2016. This research used mix method approach withcross sectional design. This research found that there is still incompleteness infilling the medical record for secondary diagnostic variables 46%, the signature ofin charge physician variable 10,5%, and supporting examination variable 1,6 %.Inaccuracy of coding diagnoses on primary diagnostic 28,2%, secondarydiagnostic 6,4% and procedur 6%. The risk of claims is delayed due to theincompleteness of medical resume amounting to Rp. 159.580.200,- ,and obtainedthe difference in claims due to inaccuracy of Rp. 7.062.100,- in November andRp. 4.821.400,- in December.The results suggested that socialization of standar operational procedur,codingpractice, reward dan punishment implementation, coding audit, coding teamformulation, and continous evaluation by management. |