STUDY PROGRAM OF HASPITAL ADMINISTRASION

POST GRADUATE PROGRAM

RESPATI INDONESIA UNIVERSITY
Thesis, July 2018

ANALYSIS OF MEDICAL RESUME FILLING COMPLETENESS AND THE

ACCURACY OF CODING DIAGNOSES AGAINST POTENTIAL RISKS OF BPJS
CLAIMS AT INPATIENT INSTALASI OF RS dr M HASSAN TOTO BOGOR IN 2018.
Ernie Burhanuddin, Soedarto Soepangat, Rachmad.
ernieburhanuddin65@gmail.com

This research discussed about medical resume completeness and the accuracy of coding
diagnoses against potential risks of BPJS claims at Inpatient Units of RS dr M Hassan Toto
Bogor in 2018
INTRODUCTION
Completeness of a medical resume is a matter that needs to be considered, because medical
resumes play an important role in ensuring the continuity of medical services and are the main
requirements in filing claims in hospitals, health centers and all health care providers (PPK) to
health insurance providers (BPJS), in addition to completeness, Medical resume must also be
on time so that the claim process runs smoothly.

METHODE
This research used mix method approach with cross sectional design.

RESULT
This research found that there is still incompleteness in filling the medical record for secondary
diagnostic variables 8,5 %, the signature of in charge physician variable 10,5%, and supporting
examination variable 1,6 %. Inaccuracy of coding diagnoses on primary diagnostic 28,2%,
secondary diagnostic 6,4% and procedur 6%. The risk of claims is delayed due to the
incompleteness of medical resume amounting to Rp. 28.225.800,- in January,and obtained the
difference in claims due to inaccuracy of Rp. 21.316.800,- in February and Rp 20,909.900,- in
March

CONCLUSION
The results suggested that socialization of standar operational procedur,coding practice, reward
dan punishment implementation, coding audit, coding team formulation, and continous
evaluation by management.

Key Word : Medical resume, Coding, BPJS Claim