KELENGKAPAN BERKAS PERSYARATAN KLAIM BPJS PADA PASIEN RAWAT INAP DI RUMAH SAKIT WAVA HUSADA MALANG

JRMIK Pub Date : 2024-01-31 DOI:10.58535/jrmik.v5i1.63

M. Ulum

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Abstract

The completeness of medical record file information is very important for verification of claims. Verification of claims is specially prepared with the aim of being a reference verifier of claims on BPJS. Completeness of medical records also maintains health facilities for service quality and efficiency of health service costs up to the disbursement of claims to health care providers. The purpose of this report is to find out the Completeness of BPJS claim requirements for inpatients at Wava Husada Hospital in 2022 with an observation method in the form of a checklist conducted on March 21-March 26, 2022. This research was conducted at the Health Financing Cooperation Installation and Casemix. Based on the results of the completeness analysis on 120 BPJS claim requirements files conducted by researchers, a completeness percentage of 75 files or 62.5% and a percentage of incompleteness of 45 files or 37.5%. The highest completeness is found in the inpatient cover letter, participant egibility letter (SEP), emergency assessment sheet, and medical support sheet with a completeness rate of 120 files or 100% and the lowest completeness is found on the casemix verification sheet of 102 files or 85%. As for overcoming this, it is recommended to hold a coordination meeting with health service providers regarding the importance of completeness and accuracy of filling out medical record files for BPJS claim requirements, to facilitate the process of submitting hospital claims to BPJS.

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马兰 WAVA HUSADA 医院住院病人 BPJS 报销要求的完整性

病历档案信息的完整性对于报销申请的核实非常重要。对报销申请的核查是专门准备的，目的是成为 BPJS 上报销申请的参考核查人。医疗记录的完整性还能维护医疗机构的服务质量和医疗服务成本的效率，直至向医疗服务提供者支付报销费用。本报告的目的是通过 2022 年 3 月 21 日至 3 月 26 日以检查表形式进行的观察方法，了解 2022 年瓦瓦胡萨达医院住院病人 BPJS 报销要求的完整性。这项研究是在医疗融资合作机构和 Casemix 进行的。根据研究人员对 120 份 BPJS 索赔要求文件进行的完整性分析结果，完整率为 75 份文件或 62.5%，不完整率为 45 份文件或 37.5%。完整率最高的是住院病人封面信、参保人可行性信（SEP）、急诊评估表和医疗支持表，完整率为 120 份，即 100%；完整率最低的是病例组合核实表，为 102 份，即 85%。为克服这一问题，建议与医疗服务提供者召开协调会议，说明完整、准确填写医疗记录档案对 BPJS 报销要求的重要性，以促进向 BPJS 提交医院报销单的过程。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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