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Article | KnE Open
KnE Medicine
ISSN: 2519-125X
The latest conference proceedings on all fields of medicine.
Causes of Dispute for COVID-19 Outpatient and Inpatient Claims at the Muhammadiyah University General Hospital of Malang
Authors:
Abstract:
Muhammadiyah University General Hospital of Malang is a COVID-19 referral hospital for Malang. Between April 2020 and June 2021, the hospital submitted 62 outpatient and 1364 inpatient cases for COVID-19 claims to the Ministry of Health of the Republic of Indonesia. The percentage of outpatient dispute claims was 25% and of inpatient dispute claims was 39%. These disputed claims disturbed the cash flow of the health facilities. The aim of our study was to describe the causes of outpatient and inpatient COVID-19 dispute claims. Our methodology was descriptive, and the secondary data were taken from claim submission documents. There were ten criteria that caused dispute claims based on KMK Number HK. 01.07/MENKES/4718/2021. This was related to administrative and medical issues. The most common cause of inpatient dispute claims (35%) was that the criteria for discharge from the hospital were not in accordance with the guarantee limit. Additionally, the most common cause of outpatient dispute claims (60%) was the management of isolation that was not related to the guidelines for management and prevention of COVID-19.
Keywords: claim dispute criteria, hospital, COVID-19
References:
[1] W. Ambarwati, “Pembiayaan Pasien COVID-19 dan Dampak Keuangan terhadap Rumah Sakit yang Melayani Pasien COVID-19 di Indonesia Analisis Periode Maret 2020 – Desember 2020.,” Jurnal Ekonomi Kesehatan Indonesia. vol. 6, no. 1, pp. 23–37, 2021.
[2] Perpres No.82, “Peraturan Presiden Republik Indonesia Nomor 82 Tahun 2018 Tentang Jaminan Kesehatan.,” Journal of Chemical Information and Modeling. vol. 53, pp. 1689–1699, 2018.
[3] Kementerian Kesehatan RI, “Keputusan menteri kesehatan republik indonesia nomor HK.01.07/menkes/4718/2021 tentang petunjuk teknis klaim penggantian biaya pelayanan pasien.,” Petunjuk Teknis Klaim Penggantian Biaya Pelayanan Pasien. vol. 2019, pp. 1–83, 2021.
[4] I. Irmawati, M. Marsum, and M. Monalisa, “Analisis Dispute Kode Diagnosis Rumah Sakit Dengan Badan Penyelenggara Jaminan Sosial (BPJS) Kesehatan.,” Jurnal Manajemen Informasi Kesehatan Indonesia. vol. 7, no. 2, p. 98, 2019.
[5] Kaufman Hall, “COVID-19 in 2021: The Potential Effect on Hospital Revenues.,” no. February, p. 2021.
[6] R. Hidayat and B. Hidayat, “Dispute Analysis of Claims for Covid-19 Patients at Hospitals of Indonesia University.,” pp. 40–49, 2020.
[7] A.A. EP, “Antonius Artanto EP. Faktor-Faktor Penyebab Klaim Tertunda BPJS Kesehatan RSUD Dr. Kanujoso Djatiwibowo Periode Januari-Maret 2016. 2016. Vol. 4.,” Jurnal ARSI. vol. 4, no. 2, pp. 122–134, 2018.