PERAN PMIK SEBAGAI KODER RAWAT JALAN TERHADAP PENGKLAIMAN JAMINAN KESEHATAN NASIONAL

Abstract

Background : Since the launch of the BPJS program, it has affected the Medical Record and Health Information (PMIK) profession as a coder, coding accuracy, and grouper on the E-Claim page for submitting claims based on the disease coder and actions affecting claims.Objective : This study aims to determine the role of PMIK as an outpatient coder for claiming national health insurance at Muhammadiyah Hospital in Bandung. Methods : The research method used is qualitative. Data collection techniques used are observation, interviews, documents, an literature study. The sampling techniques used purposive sampling technique with a total 3 officers coding outpatient BPJS patients Results : For the results of observations and interviews, several problem were found including (1) Incomplete medical resume (2) Different claim reqrutments file medical record numbers (3) The condition of the server experienced problems or disruption.Conclusion : The author provides suggestions for these problems, namely (1) The claim must be monitored and evaluated (2) The Coder provides problem information during routine meetings and coordination meetings (3) The coordinator has confirmedhow long the system maintance period

Keywords: Coder, JKN, INA-CBGs.