Identification of Factors Causing The Return of BPJS Files (Return Claim) At Dharma Yadnya General Hospital, Denpasar City, Quarter IV of 2023

I Kadek Putra Wirawan; M. Fairuz Abadi; Putu Ayu Sri Murcittowati

doi:10.35910/jbkm.v9i1.805

I Kadek Putra Wirawan STIKes Wira Medika Bali
M. Fairuz Abadi Medical Records and Health Information Study Program Three Diploma Program STIKes Wira Medika Bali
Putu Ayu Sri Murcittowati Medical Records and Health Information Study Program Three Diploma Program STIKes Wira Medika Bali

DOI: https://doi.org/10.35910/jbkm.v9i1.805

Keywords: BPJS, Retur claim, Claim file

Abstract

Background: Social Insurance Administration Organization (BPJS) has a crucial role in organizing social security programs in Indonesia. BPJS aims to ensure social protection for the community. BPJS is a legal entity that has a regulatory basis to regulate its operations. Claims are bills or demands for payment or health services provided to BPJS participants. This study aims to determine the factors causing the return of BPJS claim files at Dharma Yadnya General Hospital, Denpasar City.

Method: The sample of this study was BPJS claim files totaling 137 claim files. The research data used by researchers is secondary data. The results of this study are the percentage of BPJS returns due to coding 30.65%, due to completeness 29.20%, due to visit indications 32.12%, and due to treatment indications 8.1%. These results were obtained from a total of 137 claim files returned by BPJS.

Results: Based on the results of the study that has been carried out on the factors for returning BPJS claims at Dharma Yadnya General Hospital, it can be concluded that the largest factor in returning BPJS files is due to visit indications of 44 BPJS claim files.

Conclusion: Socialization regarding coding standard rules, visit indications, treatment indications and completeness of medical record contents should be improved.