This study aims to discuss the role of accounting in the Datu Beru Takengon Regional Hospital after BLUD status and the adoption of INA-CBGs. The role of accounting in hospitals is reflected in accounting innovations and strategies in responding to INA-CBGs. For this reason, the focus of this study is to look at accounting innovation efforts and strategies to respond to INA-CBGs carried out by the management of Datu Beru Takengon Regional Hospital. The method used in this research is a qualitative method with a case study approach. Sources of data come from informants who are selected based on certain criteria (purposive sampling). The data collection technique in this study was an interview instrument. The type of interview is a semi-structured interview. The results of this study reveal that the role of accounting in the Datu Beru Takengon Regional Hospital has increased, especially after changes to the hospital payment system, namely, INA-CBGs. Meanwhile, the change in status to BLUD did not have a direct impact on changing the role of accounting. The change in the role of accounting at the Datu Beru Takengon Regional Hospital is reflected in the accounting innovation efforts undertaken by management by involving medical personnel, especially specialist doctors in accounting practice. These specialist doctors have been asked to calculate the unit cost of each medical service using the Activity Based Costing (ABC) method. In addition, doctors have also been asked to be more concerned about controlling the cost of medical services so that they do not exceed the INA-CBGs rate. Keywords: Accounting Role, BLUD Status, INA-CBG Adoption.