Published date: Sep 15 2022

Journal Title: KnE Medicine

Issue title: The International Conference of Medicine and Health (ICMEDH)

Pages: 112–123.

DOI: 10.18502/kme.v2i3.11859

Rezky Ami Cahyaharnitamyamirezky@gmail.comMuhammadiyah University General Hospital of Malang

Thontowi Djauhari Nur SubchiDoctoral Program Faculty of Public Health Airlangga University

Subi HariyantoMuhammadiyah University General Hospital of Malang

Intan Putri AndriyaniMuhammadiyah University General Hospital of Malang

Rizki Ridha FitriMuhammadiyah University General Hospital of Malang

Husni FauziahMuhammadiyah University General Hospital of Malang

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

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