Dispute Analysis of Claims for Covid-19 Patients at Hospitals of Indonesia University

ABSTRACT Background: Indonesia is one of the countries affected by COVID-19 pandemic. In overcoming this pandemic, the government waives the service fees for COVID-19 patients. It provides an opportunity for hospitals serving COVID-19 patients to submit claims for treatment financing to the Ministry of Health. There are technical guidelines for payment; there are still frequent problems, leading to a dispute. This is also experienced by the University of Indonesia Hospital (RSUI) as one of the COVID-19 referral hospitals. This study aimed to provide an overview of the claim problem encountered and their solution. Subjects and Method: This was a descriptive study conducted at University of Indonesia Hospital from July, 2020. The theme of this study was problem in claiming payments for COVID-19 patients. Several informants were selected for this study included: hospital claim officers, medical record units, inpatient units and registration units. The data were collected by observation, in-depth interview, disputed claim data. Results: The results of the investigation found that the problem of dispute claims for COVID-19 in RSUI was dominated by the incompleteness of filling in administrative files as evidence of service practice for patients in the field, such as incomplete ventilator usage curves (7.8%), swab results (3.9%), and rapid test (6.8%) which was not listed. Conclusion: Discipline needs to be applied in the completeness of documents, and a clear flow of patient care is required to avoid incomplete records. Keywords: dispute, claim, COVID-19, hospital, health insurance Correspondence: Rakhmad Hidayat. Pascasarjana Kajian Administrasi, Fakultas Kesehatan Masyarakat Universitas Indonesia, Pondok Cina, Kecamatan Beji, Kota Depok, Jawa Barat 12345. Email: [email protected]. Mobile: (021) 7864975 DOI: https://doi.org/10.26911/the7thicph.04.17