Analysis of Pending Claim of BPJS Kesehatan Inpatient Due to Incompatibility Coding and Its Strategies at Muhammadiyah Selogiri Hospital

The study aims to determine pending claims due to inappropriate coding and strategies at Muhammadiyah Selogiri Hospital. It is a qualitative study. Data collection techniques were interviews, observation, triangulation, and other data recording forms. Data analysis includes three stages: data reduction, presentation, and conclusion. Results of the study concluded that the percentage of coding discrepancies in the pending claims of BPJS Kesehatan inpatients at Muhammadiyah Selogiri Hospital from January to June 2022 was 147 files with a rate of 57.40% of the total pending shares of 256 cases. Classification of incompatibility coding confirmation of BPJS Kesehatan inpatients in cases of pending claims at Muhammadiyah Selogiri Hospital from January to June 2022 from 147 claim files is confirmation of coding aspects with supporting examinations according to BA Mutual agreement were 66 files with a percentage of 44.90%. Confirmation of Coding Aspects according to BA Mutual agreement were 41 files with a rate of 27.89%. Confirmation of medical aspect of diagnosis based on BA mutual agreement were 21 files with a share of 14.29%. Confirmation of diagnosis coding based on ICD and confirmation of treatment coding rule based on ICD 9 CM has 19 files with a rate of 12.92%. Of the classifications, the most confirmation was coding confirmations on the diagnosis of internal specialists. The impact of coding incompatibility on pending claims of BPJS Kesehatan inpatients at Muhammadiyah Selogiri Hospital from January to June 2022 disrupted the hospital’s cash flow due to delayed income on pending claims with confirmation of coding 147 is Rp. 491,584,300, while the coding improvement following the provisions of the regulation from 147 pending claims was Rp. 397,988,950, resulting in a decrease in revenue of Rp. 93,595,350. Some factors are causing coding incompatibility for BPJS Kesehatan inpatients at Muhammadiyah Selogiri Hospital. Namely, the absence of medical device facilities required in the BA agreement, the lack of information to doctors and coders regarding the provisions in the current regulation, and doctors’ writings that were not legible by coding officers, and the coding officers have not received coding training. The institution performed some strategies for resolving pending claims of BPJS Kesehatan inpatients at Muhammadiyah Selogiri Hospital. These strategies included procuring medical devices in the spirometer, conducting IHT between doctors and coders, conducting training for a coder, making PHP-based applications, and having comparative studies in managing pending claims at the other hospitals.