Application of Failure Mode and Effects Analysis in Managing Medical Records for Accuracy of INA-CBGs Health Insurance Claims in a Tertiary Hospital in Indonesia.

OBJECTIVE

Awareness of the importance of social security systems continues to grow in Indonesia, as mandated by the amendment of the 1945 Indonesian Constitution Article 34 paragraph 2, which states the obligation of the Indonesian government to develop and implement a social security system for all Indonesian people. This study aims to evaluate the effectiveness of applying failure modes and effects analysis (FMEA) in managing inpatient medical records at the Dr. M. Djamil Padang Central General Hospital.

MATERIAL METHODS

This is a comparative research study that uses a retrospective approach and compares the data between 2017 and 2018 inpatient National Health Insurance (NHI) patient medical records. Study samples include randomly selected 24,005 files.

RESULTS

The results showed a decrease in problematic claims by 13 percent and an increase in receipt of claims paid by 87 percent. There is a significant difference between the data in 2017 and 2018 in problematic claim decrease (p=0.000) and claim acceptance increase (p=0.000).

DISCUSSION

It was found that the redesign process of the formation of hospital claims will make hospitals more organized, precise, effective, and efficient, therefore positively impacting hospital income. In addition, the redesign was carried out because of the large number of Social Security Administrator for Health patients; thus, it greatly affected hospital income.

IMPLICATION FOR HEALTH POLICIES

The FMEA medical record flow process is very effective and can thus be implemented in hospitals.