Analisis Faktor Penyebab Pending Klaim BPJS Kesehatan Rawat Inap di RS Baladhika Husada Jember
DOI:
https://doi.org/10.47134/rmik.v3i2.1911Keywords:
BPJS Kesehatan, Claim, Pending, PerformanceAbstract
Claims are requests for payment of healthcare service costs by healthcare facilities to BPJS Kesehatan. Hospitals must complete the required documents according to BPJS verification procedures to avoid pending claims. The issue of pending claims still occurs at RS Tk.III Baladhika Husada Jember, with a pending rate of 11.4% from July to December 2023. This study aims to analyze the factors causing pending BPJS Kesehatan inpatient claims at RS Tk.III Baladhika Husada Jember using Robbins’ Performance Theory. This qualitative study collected data through interviews, observations, documentation, and brainstorming. The study found that pending BPJS Kesehatan inpatient claims are caused by motivation factors (lack of a reward system), opportunity factors (absence of job descriptions, insufficient staff for casemix and TPPRI), and ability factors (staff with less than 5 years of experience, lack of knowledge about BPJS inpatient claims). The study concludes that the causes of pending BPJS Kesehatan inpatient claims are motivation, ability, and opportunity factors. Proposed improvements include creating job descriptions, regularly maintaining internet networks, recruiting new staff with medical record qualifications, and providing training to enhance staff knowledge.
References
[1] BPJS Kesehatan, “Peraturan Badan Penyelenggaraan Jaminan Sosial Kesehatan Nomor 3 Tahun 2017.”
[2] E. K. Kurnia and Mahdalena, “Faktor Penyebab Pending Klaim BPJS Kesehatan Pasien Rawat Inap di Rumah Sakit X Periode Triwulan 1 Tahun 2022.”
[3] S. Suliantoro, “Analisis Pengajuan Klaim BPJS Kesehatan Rawat Inap di Bangsal Sadewa RSUD Saptosari, Gunungkidul, Yogyakarta.”
[4] BPJS Kesehatan, “User Manual Aplikasi VClaim v. 1.4.0.”
[5] A. Heryana and Wahyudi, “Analisis beban kerja petugas pemberkasan klaim JKN rawat inap RS Premier Jatinegara 2019.”
[6] L. Indawati, “Analisis Akurasi Koding Pada Pengembalian Klaim BPJS Rawat Inap Di RSUP Fatmawati Tahun 2016.”
[7] Moehariono, Pengukuran Kinerja Berbasis Kompetensi, Revisi. Jakarta: Rajawali Pers, 2020.
[8] N. Nuraini, R. A. Wijayanti, F. Putri, G. Alfiansyah, A. Deharja, and M. W. Santi, “Optimalisasi Manajemen Penanganan Klaim Pending Pasien BPJS Rawat Inap Di Rumah Sakit Citra Husada Jember.”
[9] L. F. Wijaya, “Sistem Reward dan Punishment sebagai Pemicu dalam Meningkatkan Kinerja Karyawan.”
[10] M. Ruslan, R. Jonathan, and E. A. Lau, “Pengaruh Reward dan Punishment Terhadap Kinerja Pegawai di Dinas Pendidikan dan Kebudayaan Kabupaten Kutai Timur.”
[11] Hanisah, A. Ainy, and I. S. Budi, “A Position Analysis of BPJS Claims Administration Officers and Verifiers (Case Study: Jambi Province Regional Mental Hospital).”
[12] A. B. Triatmaja, R. A. Wijayanti, and N. Nuraini, “Tinjauan Penyebab Klaim Pending Badan Penyelenggara Jaminan Sosial (BPJS) Kesehatan Di RSU Haji Surabaya.”
[13] Listiyawati and R. A. Wijayanti, “Faktor Penyebab Pending Claim Ranap JKN Dengan Fishbone Diagram Di RSUP Dr Kariadi.”
[14] S. F. Nabila, M. W. Santi, Y. Tabrani, and A. Deharja, “Analisis Faktor Penyebab Pending Klaim Akibat Koding Berkas Rekam Medis Pasien Rawat Inap di RSUPN Dr. Cipto Mangunkusumo.”
[15] Kementerian Kesehatan Republik Indonesia, “Peraturan Menteri Kesehatan RI Nomor 312 Tahun 2020 tentang Standar Profesi Perekam Medis dan Informasi Kesehatan.”
[16] Z. A. Ritonga, “Tingkat Pengetahuan Petugas Rekam Medis Sinar Husni Medan.”
[18] S. Syamsul, R. Ardiansyah, and H. Mursidah, “YUME: Journal of Management Pengaruh Pengetahuan dan Pengalaman Kerja Terhadap Kinerja Karyawan Abstrak.”
[19] W. Setyorini, S. Khotimah, and M. Rafi’, “Pengaruh Pengetahuan Terhadap Kinerja Karyawan CV. Master Print Pangkalan Bun,” Jurnal Magenta, vol. 9, no. 2, pp. 45–52, 2021.
[20] S. Wahyuni, “Pengaruh Pelatihan Dalam Meningkatkan Produktivitas Kerja Karyawan,” no. April, p. 16, 2019.
[21] B. Pranayuda, I. Haryanti, Y. Utomo, and H. Madiistriyatno, “Analisis Penyebab Pending Klaim Pasien BPJS Kesehatan dalam Pengajuan Klaim di Rumah Sakit Umum Persahabatan.”
[22] U. Nurjanah and S. Wuryanto, “Faktor Penyebab Ketidak Efisiensi Penggunaan Tempat Tidur di Rumah Sakit Condong Catur Tahun 2017.”
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