Analisis Faktor Penyebab Keterlambatan Pangajuan Klaim BPJS Kesehatan Di RSUD S.K.Lerik Kota Kupang

Wilanti, Akulina (2024) Analisis Faktor Penyebab Keterlambatan Pangajuan Klaim BPJS Kesehatan Di RSUD S.K.Lerik Kota Kupang. Undergraduate thesis, Politeknik Negeri Jember.

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Abstract

Hospitals are healthcare institutions that provide inpatient, outpatient, and emergency services. S.K. Lerik Regional General Hospital, Kupang City, as a first level referral hospital in Kupang City, experienced delays in submitting Social Health Insurance (BPJS), occurred in March, with 277 files submitted and a delay of 23 days which impacted the disbursement of hospital operational funds. This study aimed to analyzed the factors of delay in claim submission using the 7 M method (man, material, machine, method, money, market, and minute) in S.K. Lerik Regional General Hospital, Kupang City. The type of research used was qualitative research with data collection, namely interviews, observation, documentation, and brainstorming. The research methodology employed was qualitative, involved data collection through interviews, observations, documentation, and brainstorming. The study subjects consisted of seven informants, including one head of medical records, two coding officers, two claim entry officers, and two administrative staff. The research findings indicate that delays in Social Security Administration Agency claim submissions in S.K. Lerik Regional General Hospital, Kupang City are primarily caused by human factors, including inadequate staff education and shortages, as well as material factors such as incomplete medical records, operation reports, and informed consent. Additionally, machine-related issues, such as insufficient computer availability, inadequate computer specifications, and internet connectivity problems, contribute to the delays. Methodological factors, specifically the absence of SOPs for claim submissions, and time-related factors, such as delays in returning medical records more than 2 x 24 hours after patient discharge, also play significant roles. To addressed these issues, the study suggests implementing SOPs for claim submissions, increasing human resources, particularly medical record staff, maintaining internet network reliability, holding coordination meetings regarding claim delays and staff discipline, integrating Indonesia Case-Based Groups systems, Social Health Insurance and Hospital Management Information System, and coordinating with the medical committee regarding the completeness and return of medical records.

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