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Submitted
2 January 2024
Published
30 June 2024
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Abstract

A CT Scan Simulator is a tool used to determine the size, shape, and location of a tumor to help the radiotherapy team determine the next treatment plan. Vina Estetica General Hospital is a public hospital that provides CT Scan Simulator services based on the permission of Perka BAPETEN as radiotherapy management and follow-up in malignancy cases. This study uses a descriptive method through a quantitative approach, aiming to describe the inefficiency of CT-Scan Simulator billing used as a support for diagnosis enforcement based on the Indonesian-Case Based Groups (INA CBGs) tariff costs. The technique used was purposive sampling with inclusion and exclusion criteria. Secondary data collection was carried out retrospectively in the form of claim files for the period January 2020 - November 2023 as many as 308 samples were taken randomly. The results showed that there were 283 (83%) CT Scan Simulator billing claims aimed at supporting diagnosis enforcement and resulting in billing inefficiencies in the INA CBGs claim rates being higher

Keywords

Inefficiency CT Scan Simulator Claims Administration Audit Radiotherapy Malignancy

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How to Cite
Yusti, R. (2024). Inefficiency CT Scan Simulator Billing as an Audit Initiative of National Health Insurance Claims Administration at Vina Estetica General Hospital: GAMBARAN INEFESIENSI PENAGIHAN CT SCAN SIMULATOR SEBAGAI INISIASI AWAL AUDIT ADMINISTRASI KLAIM (AAK) BPJS KESEHATAN PADA RS VINA ESTETIKA. Jurnal Jaminan Kesehatan Nasional, 4(1), 77–84. https://doi.org/10.53756/jjkn.v4i1.192
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References

  1. Ardhitya, T., & Perry, A. (2015). Faktor-Faktor Yang Melatar Belakangi Penolakan Klaim BPJS Oleh Verifikator BPJS Di RSJD Dr. Amino Gondohutomo Provinsi Jawa Tengah Tahun 2015. J. Univ. Dian Nuswantoro.
  2. BPJS Kesehatan. (2020a). Peraturan BPJS Kesehatan No. 6. Nomor 6 Tentang Sistem Pencegahan Kecurangan Dalam Pelaksanaan Program Jaminan Kesehatan.
  3. BPJS Kesehatan. (2020b). Peraturan Direksi BPJS Kesehatan Nomor 24. In Nomor 24 Pedoman Verifikasi Pasca Klaim Pelayanan Kesehatan dan Audit Administrasi Klaim Pelayanan Kesehatan Badan Penyelenggara Jaminan Sosial Kesehatan.
  4. BPJS Kesehatan. (2023). Notulensi Pembahasan Kasus-Kasus Radiologi BPJS Kesehatan. Notulensi Pembahasan Kasus-Kasus Radiologi.
  5. Cashin, C. (2009). Designing and Implementing Health Care Provider Payment Systems : How-To Manuals. In World Bank and the United States Agency for International Development (Issue April).
  6. Fattore, G., & Torbica, A. (2006). Inpatient reimbursement system in Italy: How do tariffs relate to costs? Health Care Management Science, 9(3). https://doi.org/10.1007/s10729-006-9092-2
  7. Kemenkes RI. (2019). Berita Acara Kesepakatan Bersama Panduan Penatalaksanaan Solusi Permasalahan Klaim INA-CBG Tahun 2019. Angewandte Chemie International Edition, 6(11), 951–952., 2.
  8. Koka, K., Verma, A., Dwarakanath, B. S., & Papineni, R. V. L. (2022). Technological Advancements in External Beam Radiation Therapy (EBRT): An Indispensable Tool for Cancer Treatment. In Cancer Management and Research (Vol. 14). https://doi.org/10.2147/CMAR.S351744
  9. Murti Andayani, T., Pinzon, R., & Endarti, D. (2017). PERBANDINGAN BIAYA RIIL TERHADAP TARIF INA-CBG’s PENYAKIT STROKE ISKEMIK DI RS BETHESDA YOGYAKARTA. Jurnal Manajemen Dan Pelayanan Farmasi, 7(2).
  10. Peraturan Menteri Kesehatan Republik Indonesia Nomor 26 Tahun 2021 Tentang Pedoman Indonesian Case Base Groups (INA-CBG) Dalam Pelaksanaan Jaminan Kesehatan, Handbook (2021).
  11. Perka BAPETEN No. 2. (2022). Peraturan Kepala Badan Pengawas Tenaga Nuklir Nomor 2 Tahun 2022 Tentang Perubahan Atas Badan Pengawas Tenaga Nuklir Nomor 2 Tahun 2018 Tentang Uji Kesesuaian Pesawat Sinar X Radiologi, Diagnostik dan Intervensional. Nomor 2 Tentang Perubahan Atas Badan Pengawas Tenaga Nuklir Nomor 2 Tahun 2018 Tentang Uji Kesesuaian Pesawat Sinar X Radiologi, Diagnostik Dan Intervensional.
  12. Perka BAPETEN No. 8. (2011). Peraturan Kepala Badan Pengawas Tenaga Nuklir Nomor 8 Tahun 2011 Tentang Keselamatan Radiasi dalam Penggunaan Pesawat Sinar-X Radiologi Diagnostik dan Intervensional. Nomor 8 Tentang Keselamatan Radiasi Dalam Penggunaan Pesawat Sinar-X Radiologi Diagnostik Dan Intervensional.
  13. Rezaee, M., & Letourneau, D. (2019). Assessment of Image Quality and Dosimetric Performance of CT Simulators. Journal of Medical Imaging and Radiation Sciences, 50(2). https://doi.org/10.1016/j.jmir.2019.01.005
  14. Sugiyono. (2021). Metode Penelitian Kuantitatif Kualitatif Dan R Dan D / Dr. Sugiyono; Editor: Sutopo .2021. In Pendidikan (Issue July).
  15. Vikki Harmonay. (2022, August 24). The Difference Between a CT Scanner & CT Simulator. ATLANTIS WORLDWIDE.