Hubungan Ketepatan Pemberian Kode Diagnosa Dan Tindakan Terhadap Persetujuan Klaim BPJS

Abstract

Abstract

The accuracy of coding diagnoses and patient action is very important because it is useful to facilitate the presentation of information services mainly as a determinant of patient treatment costs. Implementation of the coding performed by the coder with the ICD-10 and ICD-9. The aim of research to get an idea of the accuracy of the coding relationship diagnosis and action on approval of claims BPJS 2015. This study uses an observational cross-sectional approach, samples taken by way of systemic random sampling with a checklist and using chi square test. Based on the results of research and discussion of the accuracy of coding diagnoses and actions which 47 (54.7%) while the inappropriateness of coding diagnoses and measures a total of 39 (45.3%). BPJS claims received approval 35 (40.7%) whereas there rejected 51 (59.3%). While the results of the chi-square test the accuracy of the coding relationship diagnosis and action on the approval of claims BPJS Hospital Qadr significance values obtained from statistical test results ie, p = 0.0001. The p value <0.05, which means that Ho refused and H1 accepted that there is a relationship between the accuracy of coding diagnoses and action on approval BPJS claims. So that there is a relationship between the accuracy of coding diagnoses and action on approval BPJS claims.

Keywords: code provision accuracy diagnosis and action, claims agreement bpjs

Abstrak

Ketepatan pemberian kode diagnosis dan tindakan pasien sangat penting karena berguna untuk memudahkan pelayanan pada penyajian informasi terutama sebagai penentu biaya pengobatan pasien. Pelaksanaan pengkodean dilakukan oleh koder dengan ICD-10 dan ICD-9. Tujuan penelitian untuk mendapatkan gambaran hubungan ketepatan pemberian kode diagnosa dan tindakan terhadap persetujuan klaim BPJS tahun 2015. Penelitian ini menggunakan metode cross sectional melalui pendekatan observasional, sampel yang di ambil dengan cara systemic ramdom sampling dengan daftar tilik dan menggunakan uji chi square. Berdasarkan hasil penelitian dan pembahasan ketepatan pemberian kode diagnosa dan tindakan yaitu 47 (54,7%) sedangkan ketidaktepatan pemberian kode diagnosa dan tindakan sebanyak 39 (45,3%). Persetujuan klaim BPJS yang diterima 35 (40,7%) sedangkan ditolak ada 51 (59,3%). Sedangkan hasil uji chi-square hubungan ketepatan pemberian kode diagnosa dan tindakan terhadap persetujuan klaim BPJS di Rumah Sakit Qadr diperoleh nilai signifikasi dari hasil uji statistik yaitu p = 0,0001. Nilai p tersebut < 0,05, artinya Ho ditolak dan H₁ diterima sehingga ada hubungan antara ketepatan pemberian kode diagnosa dan tindakan terhadap persetujuan klaim BPJS. Sehingga ada hubungan antara ketepatan pemberian kode diagnosa dan tindakan terhadap persetujuan klaim BPJS.

Kata kunci : ketepatan pemberian kode diagnosa dan tindakan, persetujuan klaim bpjs