Analisis Faktor Penyebab Pending Klaim BPJS Rawat Inap di RSUD dr. Abdoer Rahem Situbondo

Miliana, Menik Putri (2022) Analisis Faktor Penyebab Pending Klaim BPJS Rawat Inap di RSUD dr. Abdoer Rahem Situbondo. Undergraduate thesis, Politeknik Negeri Jember.

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Abstract

Pending claims causes in delays of health service payment by BPJS Health so it can have an impact on operational activities at the hospital. dr. Abdoer Rahem Situbondo hospital found the inpatient BPJS claim file that was pending by the BPJS verifier. The pending number of inpatient BPJS claim files in the last quarter of 2021 reached up to 12.04% or from 1643 inpatient files submitted, 194 files were returned to be fixed. The purpose of this study was to determine the causes of pending claims for inpatient BPJS in RSUD dr. Abdoer Rahem Situbondo using the PTA (Problem Tree Analysis) method. The type of this research is qualitative with data collection techniques of observation, documentation, interviews and brainstorming. Validity test of the data is uses triangulation of sources and techniques. Based on the results, it can be known that the causes of the first level are code discrepancies, opinion differences in determining the diagnosis, and incomplete claims files. The causing factors of code discrepancy are the ability of officers to code a diagnosis is not appropriate, insufficient work facilities and information media, and monitoring and evaluation have never been done. The factors that causes opinion differences in determining the diagnosis are differences in educational background, differences in knowledge between DPJP and BPJS verifiers, and the diagnosis is not appropriate for claim requirements. The factors that causing the incomplete claim file are the officers are able to work quickly but are not thorough, insufficient work facilities and information media, then monitoring and evaluation are not routinely conducted.

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