Conference paper
The Relationship between Completeness of Medical Record Information and Accuracy of the Main Diagnostic Code with Health Social Security Administration Claim Approval
Background: In healthcare, data incompleteness could trigger medical errors during the course of care and hinder further analysis. When incomplete data emerges at the point of care, this could impact accurate diagnosis of a patient’s condition. Another major factor in maintaining patient records and obtaining proper insurance reimbursement is the accuracy of medical coding. When a claim is coded accurately, it lets the insurance payer know the particular illness or injury and the method of treatment that is necessary. This study aimed to determine the relationship between completeness of medical record information and accuracy of the main diagnostic code with Health Social Security Administration claim approval.
Subjects and Method: This was a cross-sectional study conducted at Depok Hospital, West Java, from June to July 2017. A sample of 56 inpatient medical records were selected for this study. The dependent variable was Health Social Security Administration claim approval. The independent variables were completeness of medical record information and accuracy of the main diagnostic code. The study instrument was a checklist and ICD-10 book volumes 1, 2, and 3. The bivariate analysis with Odds Ratio and chi-square was employed to analyze the data.
Results: Completeness of medical record information (OR= 53.75; 95% CI= 2.67 to 1,083; p= 0.001) and accuracy of the main diagnostic code (OR= 12.16; 95% CI= 2.84 to 52.11; p= 0.001) were positively associated with claim approval by the Health Social Security Administration.
Conclusion: Completeness of medical record information and accuracy of the diagnostic code are positively associated with claim approval by the Health Social Security Administration.
Keywords: completeness, accuracy, diagnosis code, medical record information, claim approval, Health Social Security Administration.
Correspondence:
Tiara Nadya Putrianda. Study Program in Medicine, Faculty of Medicine, Universitas Pembangunan Nasional Veteran, Jakarta. Jl. RS Fatmawati, Pondok Labu, South Jakarta 12450. Email: tiaranadya7596@gmail.com. Mobile: 087877354369.