The Diagnosis and Medical Procedures Coding Audit to Increases the Jkn Inacbg Quality of Claims at Rsud oto Iskandar Di Nata

Abstract

A claim is a demand or bill for a reward from the results of the service provided. The accuracy of diagnosis and medical Procedures codification will result in conformity in the submission of INA-CBG claims in exchange for health care costs that have been provided. For this reason, a coding audit or review needs to be carried out as one of the methods to assess the accuracy of the results of diagnosis and medical Procedures codification in order to ensure the quality of INA-CBG claims submitted by the Hospital. The research method used is descriptive analytics. The implementation of the evaluation of diseases and medical Procedures codification at Oto Iskandar Di Nata Hospital in 2021 was only carried out by external parties, namely by the coding sub-team of the Ministry of Health in November 2021 and by BPJS Kesehatan in December 2021. The causative factor has not been carried out periodic coding audits because it has not been standardized instruments that can be used to help the implementation of coding audits. Coding audits need to be carried out to assess the accuracy of diagnosis and medical Procedures codification in order to ensure the quality of INA CBG claims submitted by the Hospital. If the coding audit is carried out periodically, pending claims will decrease and the quality of claims will increase, and if the quality of claims increases then the rates paid by BPJS to the Hospital will be in accordance with the claims submitted and on time.