Analisis Faktor Penyebab Keterlambatan Penyerahan Klaim BPJS di Rumah Sakit: Literature Review

Nari, Tri Yulia (2022) Analisis Faktor Penyebab Keterlambatan Penyerahan Klaim BPJS di Rumah Sakit: Literature Review. Undergraduate thesis, Politeknik Negeri Jember.

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Abstract

Based on health facility standards, claims are submitted regularly no later than the 10th of the following month. The Previous researches showed the submission time of BPJS claims exceeded the existing standards. This caused substantial financial losses for hospitals hence payments for medical services for doctors and other health care services were hampered. This study aimed to analyze the factors which delayed the BPJS claims submission in hospitals in terms of management elements consisting of man, money, material, method, and machine. The method used in this study was a literature review sourced from Google Scholar, Crossref, and Portal Garuda with Harzing's Publish or Perish application. The results and discussion were based on the highest percentage of delay factors in submitting BPJS claims, namely the man factor of 45%. It was not a proportional number of officers compared to the number of claim files. The money factor was 20%, it was not sufficient for funds. The material factor was 80%, medical record which was not filled out entirely by doctors or nurses. The method factor was 55%, there were no regulations regarding BPJS claims. The machine factor was 65%, the facilities and infrastructure were not optimal. The way to overcome this problem is to increase the number of staff so that it is proportional to the number of patients. Optimizing the implementation of the fund budget with the activities of submitting BPJS claims. Strengthening the cooperation between doctors and nurses in hospitals in terms of claim file completeness. Making regulations regarding BPJS claims. Computer repair, and computer network.

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