The Accuracy of the Indonesian Social Health Insurance Patients Control Code towards the Hospital Cost Services
Journal Title: Journal of Medical Science And clinical Research - Year 2018, Vol 6, Issue 10
Abstract
Background: The current health care financing system in Indonesia is based on Casemix CBG'S INA (Indonesia Case Base Group's), the hospital will get the payment based on the average cost spent by a diagnosis group. The diagnosis code and medical action determine the size of the rates that appear in the INA CBG's software. In the outpatients of the control patients, the majority were only given the code Z09.8 (Follow-up examination after other treatment for other conditions) which means all examinations after hospitalization for various conditions. The provision of diagnostic codes and medical actions for outpatients if they do not pay attention to the patient's disease condition, has the potential to cause harm to the hospital. Method: This type of research is descriptive analytic with a cross-sectional design. The research subjects were the outpatient coder and internal verifier. The object of the study was medical records of Indonesian social insuranceoutpatient at the General Surgery I Polyclinic in August-October 2017 totaling 811 documents with a total of 89 samples. Results: The results of the study were 89 samples, the exact diagnosis code was 20 (22.5%), and the incorrect code was 69 (77.5%). It is inappropriate for the code to be recorded appropriately, which experienced a rates increase of 52 (58.4%), and a decrease of 17 (19.1%). The hospital has a loss of 5.60% of the rate that should be obtained by the hospital. The aspects of human resources, facilities and infrastructure are good. Conclusion: For the implementation of outpatient codification must be based on the diagnosis of disease and supporting data. Coder must be maximal in re-verifying the result of the coding using complete supporting documents.
Authors and Affiliations
Irmawati 1
Keywords
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