Analisis Faktor Penyebab Pending Klaim BPJS Rawat Inap Di Rumah Sakit Umum Kaliwates

Puspitasari, Aprillia Maya (2023) Analisis Faktor Penyebab Pending Klaim BPJS Rawat Inap Di Rumah Sakit Umum Kaliwates. Undergraduate thesis, Politeknik Negeri Jember.

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Abstract

Claim is considered as invoices for services rendered to the members of Health Social Security Organizing Agency (Badan Penyelenggara Jaminan Sosial Kesehatan) who are treated at Kaliwates General Hospital. In the first quarter of 2022, Kaliwates General Hospital experienced 6.57% pending claims. It disrupted the hospital cash flow at Kaliwates General Hospital. This study uses the Harrington-Emerson theory, the 5M element approach (Man, Material, Method, Machine and Money). On the “man” element, it discusses knowledge, experience, and training. The material element comprises particular aspect such as medical records. The method element discusses about the availability of standard operating procedures as well as the official reports of the Social Security Organizing Agency (BPJS Kesehatan). The machine element discussed about the availability and capabilities of printers, scanners, and computers. The last element is money or fund associated to the claims of the Social Security Organizing Agency (Badan Penyelenggara Jaminan Sosial). Interviews, observations, and documentation were used to collect the qualitative data. The informants are identified through purposive sampling. This study discovers incomplete medical records, lack of training for all officers who process the medical records and Social Security Organizing Agency (Badan Penyelenggara Jaminan Sosial) claims, poorly implemented socialization regarding standard operating procedures related to medical records and the claims flow, the official reports to the Social Security Organizing Agency (Badan Penyelenggara Jaminan Sosial) are frequently changed, if they do, there is a lack of socializing. The improvement initiatives should include trainings for all officers who process the medical records and Social Security Organizing Agency (Badan Penyelenggara Jaminan Sosial) claims, monitoring and evaluating of the staffs by standard operating procedures. The Social Security Organizing Agency (Badan Penyelenggara Jaminan Sosial) should also actively socialize the updated policies online and offline.

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