Analisis Faktor Penyebab Pengembalian Berkas Klaim Rawat Inap di Rumah Sakit Daerah Kalisat Jember

Jannah, Elza Arvanissa (2023) Analisis Faktor Penyebab Pengembalian Berkas Klaim Rawat Inap di Rumah Sakit Daerah Kalisat Jember. Undergraduate thesis, Politeknik Negeri Jember.

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Abstract

The claim process was very important for the hospital because it is a replacement for the cost of patients who have been treated and received treatment. At Kalisat Regional Hospital, the number of hospitalization claim files returned in the first and second quarters of 2022 reached 19.51% or out of 1,496 claim files, 292 were returned for repair by the hospital. This causes the impact of hospital income to be hampered, the disbursement of funds that should be given precisely causes the decrease in service wages to be not in accordance with the original calculation. This study aims to analyze the cause factor for the return of the hospitalization BPJS claim file by the BPJS verifier at the Kalisat Jember Regional Hospital by using 5M theory and PTA to analyze the cause factor up to the root of the problem. This type of research is qualitative with data collection techniques using interviews, observations, and documentation. The research results were obtained that in the Man Factor the officers have not been optimal in the regulatory section regarding BPJS’ claims in the implementation guidelines of the JKN program and the Officer has never attended training. In Material Factors there is an incompleteness of the hospitalization BPJS claim file. In the Factor Method, there is no SOP related to BPJS claim management. In Factor Machines, there is no overall bridging system between SIMRS and INA-CBGs applications. Efforts to improve the problem include updating knowledge with regular socialization, planning for all officers to take part in training, confirming to the officers if there is a support file needed, improving officers' precision, creating SOP designs regarding claims management, especially SOP This allows the application of claim files, as well as improving the integration or bridging system capabilities between SIMRS and INA-CBGs applications as a whole.

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