KETEPATAN RESLEKSI DIAGNOSA DAN KODE UTAMA PASIEN PROLIFERATIVE DIABETIC RETINOPATHY BERDASARKAN ATURAN MORBIDITAS PEMBIAYAAN JAMINAN KESEHATAN INA-CBG DI RUMAH SAKIT MATA BALI MANDARA

Abstract

In the national health insurance payment system, the INA-CBG (Indonesian Case Base Groups) method is used to determine health service costs based on diagnoses and disease codes. Accuracy in diagnosis and coding is very important because it has a direct impact on the funding the hospital receives from BPJS Health. This study aims to assess the accuracy of diagnosis and coding of Proliferative Diabetic Retinopathy (PDR) patients at the Bali Mandara Eye Hospital to ensure that the funding received is in accordance with the services provided. This research uses quantitative analytical methods. The population and sample of this research is the inpatient medical record documents for January-March 2024 with a sample size of 48 medical record documents. The instrument used in the observation guide is a checklist. The test used is chi square. There is a significant relationship between the accuracy of diagnosis reselection and PDR diagnosis codes with INA-CBG health insurance financing (p-Value 0.000<0.005).