Analysis of the Accuracy of INA-CBG’s Coding for Medical Rehabilitation Outpatients to Facilitate BPJS Claims at Hospital X

Authors

  • Sali Setiatin Politeknik Piksi Ganesha, Bandung, Indonesia
  • Hesti Puspita Sari Politeknik Piksi Ganesha, Bandung, Indonesia
  • Shinta Elvira Politeknik Piksi Ganesha, Bandung, Indonesia

DOI:

https://doi.org/10.38035/ijphs.v3i3.1079

Keywords:

Accuracy Of Codification, INA-CBG's, Medical Rehabilitation, BPJS Claim

Abstract

The accuracy of diagnosis and procedure coding in the INA-CBG’s system is a key factor in the smooth submission of BPJS claims at hospitals. This study aims to analyze the relationship between the accuracy of coding and the validity of BPJS claims in medical rehabilitation outpatients at Hospital X. The method used is mixed methods with a sequential explanatory approach. The quantitative stage analyzed 2,216 patient claim files for January 2025 using the Chi-square test. Next, in-depth interviews were conducted with those responsible for managing outpatient claims to explore the causes of coding inaccuracies. The results show that 96.2% of files were coded correctly, 3.8% were coded incorrectly, and all are pending claims. The Chi-square test shows a significant relationship between coding accuracy and claim eligibility (p = 0.000). Qualitative findings revealed major obstacles in the form of differences in interpretation of coding, limited training in coding, and suboptimal hospital information systems. Regular training, improved coordination between units, and development of an electronic recording system in line with medical rehabilitation service needs are recommended. This study is expected to contribute to improving the quality of medical documentation and the effectiveness of health care financing through the INA-CBG’s claims system.

References

Centers for Disease Control and Prevention. (2011). ICD-9-CM Official Guidelines for Coding and Reporting (Effective October 1, 2011). In Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/data/icd/icd9cm_guidelines_2011.pdf

Creswell, J. W. (2014). Research Design: Qualitative, Quantitative, and Mixed Methods Approaches. In SAGE Publications (4th ed.). SAGE Publications. https://doi.org/10.1088/1751-8113/44/8/085201

Dartini, Ayu, M., Wasita, Nugraha, R. R. R., & Manik, I. G. N. (2024). Analis Penyebab Pending Klaim Badan Penyelenggara Jaminan Sosial Kesehatan Pasien Rawat Inap Di Rumah Sakit Umum Daerah Wangaya. Jurnal Informasi Kesehatan Indonesia, 10(1), 1–11.

Dewi, R. S., & Setiatin, S. (2024). Analisis Penyebab Pending Klaim Bpjs Kesehatan Pasien Rawat Inap Guna Menunjang Keberhasilan Pengklaiman (Studi Kasus?: Rsud Bandung Kiwari). JHMSS (Journal of Hospital Management Services Students), 2(2), 117–125.

Fadilah, R. A., Abdussalaam, F., & Yunengsih, Y. (2024). Perancangan Sistem Informasi Konsolidasi Integritas Rekam Medis Rawat Jalan BerbasisWeb Guna Menunjang Efektivitas Pengklaiman BPJS di Rumah Sakit Hermina Arcamanik Bandung. Jurnal Indonesia?: Manajemen Informatika Dan Komunikasi, 5(2), 1921–1937. https://doi.org/10.35870/jimik.v5i2.818

Happy, A. (2018). The Implementation of INA-CBGs System Impact on Financial Performance of Public Hospital, the Indonesia Case: A Systematic Review. KnE Life Sciences, 1–16. https://doi.org/10.18502/kls.v4i9.3553

Hapsari, D., Sri Wariyanti, A., Adita Kusumawati, E., dr Suradji Tirtonegoro Klaten Jl Soeradji Tirtonegoro No, R., Selatan, K., Tengah, J., Husada Karanganyar Jl Brigjen Katamso Barat, M., Papahan Indah, G., Kec Tasikmadu, P., & Karanganyar, K. (2024). Hubungan Ketepatan Kode Diagnosis Pada Pasien Rawat Inap Dengan Persetujuan Klaim BPJS Di RSUP dr. Soeradji Tirtonegoro Klaten. Indonesian Journal of Health Information Management (IJHIM), 4(1), 1.

Kemenkes RI. (2020). Peraturan Menteri Kesehatan Republik Indonesia Nomor 3 Tahun 2020 tentang Klasifikasi dan Perizinan Rumah Sakit. 3, 1–80.

Kementerian Kesehatan Republik Indonesia. (2016). Peraturan Menteri Kesehatan Republik Indonesia Nomor 64 Tahun 2016 tentang Perubahan atas Peraturan Menteri Kesehatan Nomor 52 Tahun 2016 tentang Standar Tarif Pelayanan Kesehatan dalam Penyelenggaraan Program Jaminan Kesehatan. https://peraturan.bpk.go.id/Home/Download/105417/Permenkes Nomor 64 Tahun 2016.pdf

Kementerian Kesehatan Republik Indonesia. (2019). Standar Pelayanan Rehabilitasi Medik (Issue 1). Direktorat Jenderal Pelayanan Kesehatan, Kemenkes RI. https://manuver.tireg7.net/wp-content/uploads/2024/09/Buku-Standar-Pelayanan-Rehabilitasi-Medik-2019.pdf

Maryati, W., Rahayuningrum, I. O., & Hestiana, H. (2023). Ketepatan Kode Diagnosis Chronic Kidney Disease Dalam Mendukung Kelancaran Klaim BPJS Di Rumah Sakit. Indonesian of Health Information Management Journal (INOHIM), 11(1), 43–49. https://doi.org/10.47007/inohim.v11i1.497

Oktamianiza., Rahmadhani., Yulia, Y., Ilahi, V., Putri, K. A., & Juwita, F. S. (2024). Penyebab Pending Klaim Berdasarkan Aspek Diagnosis dan Ketepatan Kode Diagnosis. J-REMI?: Jurnal Rekam Medik Dan Informasi Kesehatan, 5(4), 282–287. https://doi.org/10.25047/j-remi.v5i4.4884

Organization, W. H. (2019). International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Volume 2 (Vol. 2). World Health Organization. https://icd.who.int/browse10/Content/statichtml/ICD10Volume2_en_2019.pdf

Peraturan Presiden. (2018). Peraturan Presiden Republik Indonesia Nomor 82 Tahun 2018 Tentang Jaminan Kesehatan. Undang-Undang, 1, 1–74.

Permenkes No. 24. (2022). Peraturan Menteri Kesehatan RI No 24 tahun 2022 tentang Rekam Medis. Peraturan Menteri Kesehatan Republik Indonesia Nomor 24 Tahun 2022, 151(2), 1–19.

Ramadhiane, I., & Sari, I. (2021). Tinjauan Pengetahuan Perekam Medis dan Informasi Kesehatan Mengenai Aturan Penggunaan ICD 10 dalam Menentukan Diagnosa di RS Bhayangkara TK II Sartika Asih Bandung. Jurnal Health Sains, 2(8), 1014–1022. https://doi.org/10.46799/jhs.v2i8.211

Rizki, J. N., Sari, A. A., & Suprihatin, E. (2025). Penyebab Pengembalian Klaim BPJS Rawat Inap Triwulan 1 Tahun 2024 di RSI Sultan Agung Semarang. J-REMI?: Jurnal Rekam Medik Dan Informasi Kesehatan, 6(2), 156–167. https://doi.org/10.25047/j-remi.v6i2.5853

Sitorus, M. S., Simanjuntak, E., Erlindai, E., Hutasoit, T., & Lumbantoruan, P. M. A. (2023). Hubungan Ketidaktepatan Kode Diagnosa Pasien Rawat Inap Dengan Pending Klaim Ina-Cbg’s Di Rsud Sultan Sulaiman Serdang Bedagai. Jurnal Kesehatan Tambusai, 4(4), 6038–6050. https://doi.org/10.31004/jkt.v4i4.21495

Sugiyono. (2022). Metode Penelitian Kombinasi (Mixed Methods). In Alfabeta (Vol. 28, Issue 17). Alfabeta. https://www.scribd.com/document/691644831/Metode-Penelitian-2022-SUGIYONO

Triatmaja, A. B., Wijayanti, R. A., & Nuraini, N. (2022). Tinjauan Penyebab Klaim Pending Badan Penyelenggara Jaminan Sosial (Bpjs) Kesehatan Di Rsu Haji Surabaya. J-REMI?: Jurnal Rekam Medik Dan Informasi Kesehatan, 3(2), 131–138. https://doi.org/10.25047/j-remi.v3i2.2252

Widaningtyas, E., Putri Novinawati, F., & Asmorowati, A. (2024). Analisis Pending Klaim Bpjs Rawat Inap Di Rumah Sakit Qim Batang Tahun 2022. Avicenna?: Journal of Health Research, 7(1), 42–53. https://doi.org/10.36419/avicenna.v7i1.1028

Published

2025-07-01