Analisis Faktor Penyebab Perbedaan Tarif Klaim INA-CBG’S dengan Tarif Riil di RSIA Muhammadiyah Kota Probolinggo Pada Pelayanan Rawat Inap Tahun 2022

Alvianti, Dhevi Maulida (2023) Analisis Faktor Penyebab Perbedaan Tarif Klaim INA-CBG’S dengan Tarif Riil di RSIA Muhammadiyah Kota Probolinggo Pada Pelayanan Rawat Inap Tahun 2022. Undergraduate thesis, Politeknik Negeri Jember.

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Abstract

The difference fares is difference between hospital real fares and INA-CBG's claim fares. On January-May 2022 there was a difference from INA-CBG's claim fares and hospital real fares in cases of inpatient services at RSIA Muhammadiyah Probolinggo City. Total of 1,852 files with a percentage of 82.9% experienced different fares. This study aims to analyze factors causing of difference in INA- CBG's claim fares with RSIA Muhammadiyah Probolinggo City real fares for inpatient services based on individual, organizational, and psychological factors. The research method used is qualitative research with data collection techniques of interviews, observation, documentation, and brainstorming. The results shows that individual factors isn’t the cause of the problem. Officers have adequate abilities and skills as well as educational background and experience. Organizational factors are the cause of the problem is special casemix team has not been formed, a clinical pathway has not been implemented, there is no jobdesc to oversee claim process activities and in-depth evaluation has not been carried out regarding the problem. Psychological factors are not the cause of the problem. The attitude from officer has a good response. Reward and punishment have been implemented in the form of praise and verbal warning. The efforts to fix this problem include need to form a casemix team, implement a clinical pathway, carry out an evaluation of the problem and also re-establish hospital fares and create a jobdesc for the head of casemix related to supervising claims issues including incidents of different fares. The hospital is advised to have notes to control the completeness of the claim requirements, increase the number of medical record officers, and INA-CBG’s coder and claim grouping officers need to attend seminar/workshop/socialization regularly.

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