Penyebab Pending dan Dispute Klaim Kasus Covid-19 Di Rumah Sakit Tipe C dan D Jawa Tengah

Khamna Diah Oktavia Chalimah; Sutrisno Sutrisno; Umi Hanik; Umi Maftukhah; Suyoko Suyoko; Faik Agiwahyuanto; Deddy Setiadi

doi:10.25047/j-remi.v5i2.4286

Penulis

Khamna Diah Oktavia Chalimah Universitas Dian Nuswantoro
Sutrisno Universitas Dian Nuswantoro
Umi Hanik Universitas Dian Nuswantoro
Umi Maftukhah Universitas Dian Nuswantoro
Suyoko Suyoko Universitas Dian Nuswantoro
Faik Agiwahyuanto Universitas Dian Nuswantoro
Deddy Setiadi RSUP Dr. Kariadi Semarang

DOI:

https://doi.org/10.25047/j-remi.v5i2.4286

Kata Kunci:

Claim, Covid-19, Dispute, Pending

Abstrak

Covid-19 is new challenge for hospitals in reviving disaster case procedures as primary health service that treats Covid-19 patients. Returning claims cases for treating Covid-19 patients cost from BPJS Health often occur due to administrative and service problems. Claims number 2021 in type C and D hospitals Central Java was 215 pending files and 32 dispute files. This study analyzes causes of pending and dispute claims for Covid-19 patient care costs in Type C and D hospitals in Central Java. Research method is descriptive by observing all pending files and dispute claims for covid-19 cases in 2021 totaling 247. Data collection is documentation. Data analysis using univariate analysis. Results showed that pending claims for Covid-19 cases were mostly Panti Wilasa Dr. Cipto Semarang. Most dispute claims were at Kelet Jepara Hospital. Most pending claims lacked supporting files for claims and/or supporting files for claims were not appropriate and smallest were cases where scans of laboratory results (albumin, PCR) were not attached and cases of entry/exit dates in INA-CBGs did not match Medical Resume. Largest Covid-19 case claim dispute is mismatch between diagnosis and diagnostic measures results and KMK technical guidelines and smallest case is mismatch between diagnosis and action results.

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