Faktor – Faktor Penyebab Keterlambatan Pengajuan Klaim BPJS Rawat Inap di Rumah Sakit Umum dr. H. Koesnadi Bondowoso

Damayanti, Desnia Sindi (2021) Faktor – Faktor Penyebab Keterlambatan Pengajuan Klaim BPJS Rawat Inap di Rumah Sakit Umum dr. H. Koesnadi Bondowoso. Undergraduate thesis, Politeknik Negeri Jember.

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Abstract

The submission of BPJS claims by health care facilities is based on the technical verification manual maximum of the 10th of the next month. The process of submitting inpatient BPJS claims at RSU dr. H. Koesnadi Bondowoso delayed where the submissions in October 2019 overdue the 10th of the following month, which was 130 days late. The purpose of this study analyzes the factors that cause delayed in submitting inpatient BPJS claims. The type of qualitative research looks for causal factors based on personal factors, leadership factors, team factors, system factors and contextual/situational factors using Problem Tree Analysis. Data collection techniques are in-depth interviews, observation, documentation and brainstorming. The results showed lack of knowledge related to deadline for submitting BPJS claims and delay in file submission from inpatient rooms caused delay in sumbittng claims. Incomplete files for inpatient BPJS, internal verifier has multiple job and lack of guidance from chief nurse also causes of delay in submitting claims. Another causes are no standard operating procedures, hospital information management system and scanner error, increase of workload, and the work environment less supportive due to the Covid-19 pandemic. The solutions are make standard operating procedures for submitting inpatient BPJS claims, discipline employees, give rewards, and more employess to the Controller Department.

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