Analisis Faktor Penyebab Pending Klaim BPJS Rawat Inap Dengan Pendekatan Plan, Do, Check, Act (PDCA) Di RS Bladhika Husada Jember

Apsari, Faradila Dwi (2023) Analisis Faktor Penyebab Pending Klaim BPJS Rawat Inap Dengan Pendekatan Plan, Do, Check, Act (PDCA) Di RS Bladhika Husada Jember. Diploma thesis, Politeknik Negeri Jember.

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Abstract

Claim files are files that are used as material for submitting claims to the Social Security Agency of Health. Problems with pending claims still occur at Baladhika Husada Hospital in Jember. Claim files pending for 6 months averaged 7.48%, and the highest percentage was in March, which with 12.1%. The purpose of this study was to analyze pending inpatient claims using the Plan, Do, Check, Act (PDCA) approach at Baladhika Husada Hospital, Jember. This type of research is qualitative. The data collection used was interviews, observation, documentation, and brainstorming, which were conducted on 6 informants, namely 1 head of medical records, 3 internal verifiers, and 2 doctors in charge of patients. Based on the research results at the Plan stage, namely looking for factors that cause pending claims, then examining the factors that are most likely to cause pending claims, namely incomplete claims file requirements, and brainstorming plan agreements, namely solutions that can be carried out, namely by planning the preparation of standard operating procedures for submitting claims. The Do stage, namely, the researcher makes a standard operating procedure, and the officer applies the standard operating procedure to the related unit. The Check stage is checking pending claims, namely, the results of submitting claims at Baladhika Husada Hospital have decreased. The Action Stage resulted in an agreement that the standard operating procedure would still be implemented. Keywords: BPJS Claims, Medical Records, Pending, PDCA

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