ANALISIS FAKTOR PENDING KLAIM BPJS KESEHATAN PADA PASIEN RAWAT INAP DI RUMAH SAKIT PANTI WILASA
CITARUM SEMARANG PERIODE BULAN SEPTEMBER 2024
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Judul
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ANALISIS FAKTOR PENDING KLAIM BPJS KESEHATAN PADA PASIEN RAWAT INAP DI RUMAH SAKIT PANTI WILASA
CITARUM SEMARANG PERIODE BULAN SEPTEMBER 2024
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Subject
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Manajemen Informasi Kesehatan
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Abstract
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The$re$ are$ 3 (thre$e$) aspe$cts in the$ pe$nding BPJS He$alth claims for inpatie$nt patie$nts at Rumah Sakit Panti Wilasa Citarum Se$marang, name$ly administration, coding, and me$dical. The$ purpose$ of this study is to ide$ntify the$ factors causing the$ pe$nding claims, the$ir re$solution, and to improve$ the$ consiste$ncy in proce$ssing he$althcare$ costs at Rumah Sakit Panti Wilasa Citarum Se$marang by using a qualitative$ re$se$arch me$thod with a de$scriptive$ approach, aime$d at de$scribing and illustrating the$ e$xpe$rie$nce$s of the$ subje$cts be$ing studie$d and the$ re$sults obtaine$d re$late$d to the$ pe$nding BPJS He$alth claims for inpatie$nt patie$nts by obse$rving, re$cording, calculating pe$rce$ntage$s, and conducting inte$rvie$ws with 8 (e$ight) informants from the$ inpatie$nt case$mix de$partme$nt. The$ re$se$arch re$sults, base$d on 376 pe$nding claims re$port sample$s, show that the$ factors causing the$ pe$nding claims due$ to administration we$re$ 82 (21.8%), coding 88 (23.4%), and me$dical 206 (54.8%). To minimize$ the$ numbe$r of pe$nding claims, the$ hospital should hold re$gular me$e$tings be$twe$e$n Rumah Sakit Panti Wilasa Citarum Se$marang and BPJS He$alth to discuss administrative$ agre$e$me$nts, the$ comple$te$ne$ss of me$dical supporting docume$nts and coding, pe$rform re$-che$cks for the$ comple$te$ne$ss of supporting re$port docume$nts, administrative$ file$s, and diagnostic coding, conduct socialization with the$ Patie$nt Re$sponsible$ Doctor (DPJP) re$garding BPJS He$alth re$gulations, and optimize$ the$ comple$tion of me$dical re$sume$s according to BPJS He$alth re$gulations so that the$ re$sume$ conte$nt is more$ comple$te$ and can re$fle$ct the$ patie$nt’s condition.
Keywords: Factors of Pe$nding BPJS Claims, Inpatie$nt, Rumah Sakit Panti Wilasa Citarum.
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Creator
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Michael Wibowo Santoso,
Dody Indra Sumantiawan
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Language
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Indonesia
