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| Advisor(s) | Ahmad Fatikus Saleh | |
| Author(s) | ANASTASYA KHORIZA | |
| Issued Date | 2026 | |
| Abstract | The process of submitting claims from hospitals to BPJS Kesehatan (Indonesia's national health insurance provider) involves a rigorous verification stage to ensure efficiency and prevent fraud. One important instrument in this process is the Indonesian Case Base Groups (INA-CBGs) system, which relies on the accuracy of diagnosis coding (ICD-10) and procedure coding (ICD-9-CM). Discrepancies in this process often trigger claim audits by BPJS Kesehatan. This study aims to identify the factors that cause BPJS Kesehatan claim audits at Imelda Pekerja Indonesia General Hospital in 2025. This research is a descriptive qualitative study with a cross-sectional design. Data were collected through observation and interviews with coding staff, as well as review of claim files subject to audit. The research focus covers aspects of coding accuracy, medical record completeness, and other administrative factors such as readmission cases and service fragmentation. Preliminary survey results show that in 2025 there were 386 claim audit cases at Imelda Pekerja Indonesia General Hospital. The main factors causing these audits include incomplete patient medical records, errors in determining diagnosis and procedure codes, and the occurrence of readmission cases (repeated inpatient care within ≤30 days with the same diagnosis). This study is expected to provide the hospital with an objective overview for evaluating coding performance and medical record management in order to minimize the risk of audits in the future. | 1 |
| Item Type | Skripsi | |
| Keywords | Audit Klaim (Claim Audit), BPJS Kesehatan(BPJS Kesehatan) Koding(Coding), INA-CBGs(INA-CBGs),Rekam Medis(Medical Records). | 1 |
| Collection | Fakultas Kesehatan Masyarakat, D4-Manajemen Informasi Kesehatan | |
| Publisher | Institut Kesehatan Deli Husada Deli Tua | |
| Submitted Date | 20-10-2026 | |
| Updated Date | 20-10-2026 | |
| URI | No URI | |
| File |
SKRIPSI_ANASTASYA KHORIZA_25199003.pdf
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