Analysis of the Completeness of the Summary of Inpatient Discharge in Support of the Health Insurance Claim Process
DOI:
https://doi.org/10.69855/rekammedis.v2i1.707Keywords:
Medical Record, Completeness, Discharge Summary, Patient, Claim, BPJSAbstract
Completeness of the inpatient summary of discharge is an important component of medical records in supporting health insurance claims. Incompleteness of this document can cause verification problems, file returns, and delayed claim payments. This study aims to analyze the completeness of the inpatient summary of discharge in supporting the health insurance claim process. The study used a quantitative method with an analytical cross-sectional design and was conducted at the Medical Record Installation of dr. Rasidin Hospital, Padang. The population consisted of all inpatient medical record files of BPJS participants submitted for claims. A sample of 180 files was selected using systematic random sampling. Data were collected through observation using a discharge summary completeness checklist and health insurance claim status review. Univariate analysis used frequency distribution, while bivariate analysis used the Chi-Square test with a 95% confidence level. The results showed that 154 files (85.6%) were complete and 26 files (14.4%) were incomplete. A total of 165 files (91.7%) were processed without problems, while 15 files (8.3%) had pending claims. The Chi-Square test showed a significant relationship between discharge summary completeness and health insurance claims (p=0.001). The Odds Ratio (OR) of 8.25 (95% CI: 2.89–23.57) indicated that incomplete discharge summaries had 8.25 times greater odds of pending claims. Hospitals should strengthen monitoring, periodic medical record audits, and staff compliance to optimize the claims process.
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