ANALISIS PROSES PENGAJUAN KLAIM JAMINAN KESEHATAN NASIONAL PADA PELAYANAN RAWAT INAP DI RSUD KABUPATEN EMPAT LAWANG

ARIANY, RELIA and Ainy, Asmaripa (2018) ANALISIS PROSES PENGAJUAN KLAIM JAMINAN KESEHATAN NASIONAL PADA PELAYANAN RAWAT INAP DI RSUD KABUPATEN EMPAT LAWANG. Undergraduate thesis, Sriwijaya University.

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Abstract

RSUD Kabupaten Empat Lawang is submmiting claim for services provided to patients participating in the Jaminan Kesehatan Nasional (JKN) to BPJS of Health Lubuklinggau. In 2018 RSUD Kabupaten Empat Lawang hospital experienced problems in the administration of claims for hospitalization. It is proven by the number of inpatient claim sheaf returned for monthly services February-April 2018 is 27,67% more than outpatient sheaf. The purpose of this study was to analyze the input components and processes that affect the output of problematic inpatient claims sheaf. This research is a qualitative descriptive study. The methods used are in-depth interviews, observation and document review. 8 informants were selected by purposive sampling technique, the research was done surroundings RSUD Kabupaten Empat Lawang. To see the validity of the information obtained, it uses the validity test using triangulation, the results are presented in narrative form. Input variables that effected the process of submitting inpatient claims are Human Resources, tool and Hospital bylaws. The process variables carried out are analyzing files, coding, calculating real costs, verifying and data entry to the INA-CBG's application. The output produced is a claim sheaf for one month of service that will be sent to BPJS Kesehatan for verification. The problem of claims faced is that there is still a delay in collecting patient status for analysis, coder have difficulty in coding several cases and problems with internet networks and problems with application upgrades in INA-CBG’s applications. These problems have an impact on the late submission of claims to BPJS Health and claim status after being verified by BPJS Health verifier. Hospitals need to change the director's decree which regulates the administrative process of claims and coordinates with the local government to improve telecommunications networks, training for coders is needed so that problems in codification can be minimized.

Item Type: Thesis (Undergraduate)
Uncontrolled Keywords: claim, inpatients, JKN
Subjects: R Medicine > RA Public aspects of medicine > RA399 Regulation of medical practice. Evaluation and quality control of medical care. Medical audit
Divisions: Faculty of Public Health > 13201-Public Health (S1)
Depositing User: Relia Ariany
Date Deposited: 07 Aug 2019 04:16
Last Modified: 07 Aug 2019 04:16
URI: http://repository.unsri.ac.id/id/eprint/2658

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