Larasty, Gevi (2023) ANALISIS PENYEBAB PENDING KLAIM BERKAS BPJS KESEHATAN PELAYANAN PASIEN RAWAT INAP DI RUMAH SAKIT X. D3 Rekam Medis dan Informasi Kesehatan thesis, Universitas Awal Bros.
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Abstract
PROGRAM STUDI DIII REKAM MEDIS DAN INFORMASI KESEHATAN UNIVERSITAS AWAL BROS Karya Tulis Ilmiah (KTI), 2023 ANALISIS PENYEBAB PENDING KLAIM BERKAS BPJS KESEHATAN PELAYANAN PASIEN RAWAT INAP DI RUMAH SAKIT X Gevi Larasty, 00420009 XVIII+ 53 Halaman + 18 Tabel + 2 Gambar + 3 Grafik + 7 Lampiran ABSTRAK Latar Belakang : Berkas klaim BPJS Kesehatan Triwulan 1 Januari, Februari dan Maret tahun 2023 dengan 129 berkas klaim BPJS kesehatan pelayanan pasien rawat inap yang terpending. Alasan pengembaliannya karena tidak lolos verifikasi administrasi pelayanan, perbedaan koding diagnosa antara koder BPJS dengan kode diagnosa rumah sakit dan ketidaklengkapan berkas klaim BPJS (scan berkas tidak jelas) sehingga susah dibaca. Karena kesulitan dalam penyelesaian klaim tersebut, hal ini mengakibatkan adanya pending klaim yang mengganggu aliran keuangan rumah sakit. Tujuan : Untuk mengetahui klaim berkas BPJS Kesehatan pelayanan pasien rawat inap yang terpending di Rumah Sakit X. Metode : Metode penelitian di penelitian ini memakai metode Deskriptif kuantitatif dengan melakukan checklist dokumen berdasarkan pendekatan cross-sectional dari variabel administrasi kepesertaan, pelayanan dan kesehatan. Hasil : Presentase faktor penyebab pending klaim BPJS kesehatan pelayanan pasien rawat inap berdasarkan kesesuaian administrasi kepesertaan yakni sesuai 100%. Presentase faktor penyebab pending klaim BPJS kesehatan pelayanan pasien rawat inap berdasarkan kesesuaian administrasi pelayanan yakni sesuai 91,6% . Yang tidak sesuai 8,4%. Dan presentase faktor penyebab pending klaim BPJS kesehatan pelayanan pasien rawat inap berdasarkan kesesuaian administrasi kesehatan yakni sesuai 94,7% yang tidak sesuai 5,3 %. Kesimpulan : Terpendingnya berkas klaim BPJS kesehatan pelayanan pasien rawat inap dalam unsur monitoring yang kurang dalam pengisian data formulir persyaratan rawat inap, aturan pemeriksaan teknis pengkodingan sesuai dengan petunjuk verifikasi klaim BPJS kesehatan. Dan aturan pemberian kode pada diagnosis maupun tindakan ICD 10 dan ICD 9. Kata Kunci : BPJS, Pengajuan Klaim, Pasien rawat inap Kepustakaan : 11 Buku (2013-2021) + 34 Jurnal PROGRAM STUDI DIII REKAM MEDIS DAN INFORMASI KESEHATAN UNIVERSITAS AWAL BROS Karya Tulis Ilmiah (KTI), 2023 ANALYSIS OF THE CAUSES OF PENDING CLAIMS OF HEALTH BPJS FILES SERVICES INPATIENT PATIENTS AT HOSPITAL X Gevi Larasty, 00420009 XVIII+ 53 Halaman + 18 Tabel + 2 Gambar + 3 Grafik + 7 Lampiran ABSTRACT Background : BPJS Health claim files Quarterly 1 January, February and March 2023 with the pending 129 BPJS health claim files for inpatient services. The reason for returning it was because it did not pass the service administration verification, the difference in diagnostic coding between the BPJS coder and the hospital diagnosis code and the incompleteness of the BPJS claim file (the file scan was not clear) making it difficult to read. Due to difficulties in settling these claims, this resulted in pending claims which disrupted the hospital's financial flow. Method : To find out the BPJS Health file claims for the pending inpatient services at Hospital X. Method : The research method in this study used a quantitative descriptive method by conducting a checklist of documents based on a cross-sectional approach to membership, service and health administration variables. Results : The percentage of factors causing pending claims for BPJS inpatient services based on the suitability of membership administration is 100%. The percentage of factors that cause pending claims for BPJS inpatient services based on the appropriateness of service administration is 91.6%. The non-conforming 8.4%. And the percentage of factors causing pending BPJS health claims for inpatient services based on the suitability of health administration is 94.7%, which is not 5.3%. Conclusion : The pending BPJS health claims file for inpatient services is lacking in monitoring elements in filling in the inpatient requirements form data, coding technical rules in accordance with the BPJS health claims verification instructions. And the rules for assigning codes to ICD 10 and ICD 9 diagnoses and actions. Keywords : BPJS, Filing a claim, Inpatients Library : 11 Books (2013-2021) + 34 Journals
| Item Type: | Thesis (D3 Rekam Medis dan Informasi Kesehatan) |
|---|---|
| Subjects: | D3 Rekam Medis > Layanan Publik D3 Rekam Medis > Layanan Rekam Medis |
| Divisions: | D3 Rekam Medis |
| Depositing User: | lib. psdku. univawalbros |
| Date Deposited: | 31 May 2024 04:21 |
| Last Modified: | 24 Jun 2024 09:25 |
| URI: | http://repositori.psdku.univawalbros.ac.id/id/eprint/297 |
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