Analisis Faktor Penyebab Pending Klaim BPJS Rawat Inap di RSUD Genteng

Indriyani, Novita (2024) Analisis Faktor Penyebab Pending Klaim BPJS Rawat Inap di RSUD Genteng. Undergraduate thesis, Politeknik Negeri Jember.

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Abstract

BPJS claims are reports to BPJS Health on the medical expenses of BPJS patients, carried out collectively and billed to BPJS Health every month. Based on the results of preliminary studies at Genteng Hospital, it was found that the number of pending inpatient claims in the fourth quarter of 2023 was 262 claims (11.33%) of 2313 files submitted. The purpose of this study is to analyze the factors causing pending BPJS inpatient claims based on Gibson's performance variables. This type of research is qualitative with data collection techniques of documentation, observation, and interviews. The results of research on individual variables are inaccuracies and errors in determining codes, organizational variables are internet networks, software and hardware errors, SIMRS has not been bridging with e-claim and v-claim applications, manual medical resume writing and the absence of SOPs governing the implementation of inpatient BPJS claims, psychological variables, namely there are differences in perceptions between coding officers and BPJS verifiers and there is no provision of rewards and punishments. The results of prioritizing problems using the ultrasound method are incorrectly determining the code because the writing of the diagnosis is less specific. Efforts to solve the problem are to confirm with the DPJP or room admin regarding clarity in writing a diagnosis or medical resume and increasing the understanding and accuracy of coding officers by attending training.

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