| Summary: | Background: One of the requirements of the insurance claim is a medical
resume, which contains clinical data of patients and can be used for insurance
reimbursement. Resume must be filled full medical because one of the
consequences if it is not fully complete will hinder the process of insurance
claims. Based on the preliminary study on December 27, 2012 at the General
Hospital in Yogyakarta, researchers found an incompleteness in terms of
insurance claims and Jampersal Jamkesma. Seeing these problems, medical
records clerk was doing the effort by adding a memo on incomplete
requirements. Incompleteness claim terms should make medical records clerk to
the filing room to find the patient's medical record file in question and
photocopied sheets that do not exist in terms of insurance claims and Jampersal
Jamkesmas. However, these efforts have not been able to significantly improve
the completeness of requirements and insurance claims Jamkesmas Jampersal.
Objective: to know the percentage of completion requirements and Jampersal
JamkesMas insurance claims, determine the percentage of complete medical
resume charging patients and insurance Jamkesmas Jampersal, knowing the
cause of the incompleteness of the insurance claim requirements and Jampersal
Jamkesmas on the INA-CBGs.
Methods: This type of study is a descriptive study with a qualitative approach.
Collecting data using interview techniques (interviews), observations
(observation) and study documentation. The research was performed at the
Hospital Medical Records Yogyakarta and was held on March 21, 2013 up to 23
April 2013.
Results: The percentage is in terms of insurance claims Jamkesmas sheet in
case of IRD patients - hospital inpatient in the city of Yogyakarta by 88%, no
12%, whereas in the case of ambulatory patients - inpatient, the percentage is on
the sheet requirements by 87% , there is no 13%. Then there is the percentage of
insurance claims Jampersal sheet requirements in the case of IRD patients -
hospital inpatient in the city of Yogyakarta by 88%, no 12%, whereas in the case
of ambulatory patients - inpatient, there are a percentage of 83%, no 17 %.
Analysis of medical resumes in hospitals in Yogyakarta is known percentage
Jamkesmas patient identification and review for completeness Jampersal by 73%
and 51%, incompleteness by 7% and 3%, ketidakterisian by 20% and 46%.
Important reports, completeness of 79% and 79%, the incompleteness of 1% and
0, ketidakterisian by 20% and 21%. Authentication, completeness of 21% and
6%, incompleteness by 79% and 94%, ketidakterisian 0. Documentation is true,
there is right at 48% and 57%, there is not really equal to 17% and 6%, not filled
by 35% and 37%. Cause of incomplete insurance claim requirements and
Jampersal Jamkesmas, which many busy physicians because patients, doctors
did not immediately fill medical resume after patients go home, the nurse did not
know that a resume is one of the requirements of medical insurance claims
Jampersal, nurses do not understand what has disosialisakian medical records
clerk Installation and Chief Medical Record, the nurse did not complete all items
of the patient's identity, the lack of standard operating procedures and policies of
charging medical resume.
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