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Pada saat ini pelayanan kesehatan dihadapkan pada situasi persaingan yang tinggi, untuk itu diperlukan suatu usaha meningkatkan pelayanan kesehatan yang berkualitas. Pelayanan kesehatan yang berkualitas memerlukan sumber daya manusia yang memiliki kualitas kinerja yang baik. Dalam upaya mencapai hal tersebut perlu dilakukan berbagai usaha. Penelitian ini melihat hubungan antara Persepsi karyawan tentang kepemimpinan religius kepala rumah sakit dan kinerja baik secara langsung maupun melalui motivasi kerja karyawan di Rumah Sakit Bersalin Duren Tiga. Hasil penelitian menyimpulkan bahwa persepsi karyawan tentang kepemimpinan religius kepala rumah sakit tidak berhubungan secara langsung dengan kinerja karyawan melainkan melalui motivasi kerja karyawan Rumah Sakit Bersalin Duren Tiga.
At this time of health services are faced with a situation of high competition, for it required an effort to improve health care quality. Quality health services requires human resources that have a good quality performance. In the effort to achieve this needs to be done a variety of activity. This study looked at the relationship between employee perceptions about the hospital's head of religious leadership and performance, both directly and through employee motivation at the Duren Tiga Maternity Hospital. This study concluded that the perceptions of employees about the hospital?s headof religious leadership is not directly related to employee performance but through employee motivation.
Hasil penelitian menunjukkan adanya penyebab pending claims yang disebabkan oleh faktor input (Man, Method, Money, Material, Machine), proses dan output. Salah satu penyebab adalah pengisian resume medis yang tidak sesuai (output), disebabkan karena pengisian resume medis terlambat dan ketidaksesuaian isi resume medis (proses) yang diakibatkan oleh faktor input (Man, Method, Money, Material, Machine). Gambaran pending claims (output) di RSUD Jati Padang adalah karena ketidaksesuaian Administrasi Klaim (17.89%), pengisian resume medis (57.51%), ketidaklengkapan berkas penunjang klaim (13.42%), konfirmasi coding diagnosa dan prosedur (8.95%) dan konfirmasi grouping (2.24%). Pengajuan klaim kepada BPJS Kesehatan selalu dilakukan diatas tanggal 5, dengan rata- rata keterlambatan 6.6 hari. Total jumlah berkas klaim BPJS Kesehatan bulan Januari-September 2018 yang disetujui pada tahap 1 adalah sebesar 3759 berkas (92.36%) dengan total tagihan yang disetujui Rp 1.180.532.000 (74.38%). Diperlukan strategi dari manajemen rumah sakit untuk dapat mencegah dan mengurangi pending claims. Salah satunya dengan pemberian remunerasi kepada dokter spesialis, penyusunan Panduan Praktik Klinis dan kelengkapan SOP terkait adminitrasi klaim, adanya monitoring evaluasi berkala mengenai permasalahan proses klaim BPJS
Kata Kunci: rumah sakit, penyebab, penundaan klaim, BPJS Kesehatan
The Indonesian Act No. 40 of 2004 mandates that everyone has the right to social security through the Indonesian National Health Insurance (JKN) in achieving Universal Health Coverage (UHC) in 2019. On JKN, the payment system to hospitals on JKN is set with Indonesian-Case Based Groups (INA- CBGs) tariff, through claim management system where each problem can cause delays in claim payments by National Health Care Security and affect hospital income. The financial sustainability of health facilities is highly dependent on an effective claim management system. Rumah Sakit Umum Daerah Jati Padang as a Regional Public Service Agency needs to manage financial management effectively so that health services delivery is well-provided. One of financial source for RSUD Jati Padang is through National Health Care Security claims payment. Every pending claim will be resulted in disrupted hospital revenue. This research objective was to analyze causes factors of National Health Care Security pending claims using the system approach, which are input factors (Man, Method, Money, Material, Machine), process factors, output (pending claims). This research is a qualitative study. Data is collected with document review and in-depth interviews.
The results showed that there were causes of pending claims caused by input factors (Man, Method, Money, Material, Machine), process and output. One of the causes is improper medical resume filling (output), caused by delay in filling in medical resume and incompatibility of medical resume content (process) and triggered by input factors (Man, Method, Money, Material). The description of pending claims (output) at Jati Padang Hospital is due to discrepancies in claim administration (17.89%), filling in medical resumes (57.51%), incomplete claim support documents (13.42%), confirmation of diagnostic diagnoses and procedures (8.95%) and grouping confirmation (2.24%). National Health Care Security claims are submitted to National Health Care Security verificator pass the 5th, with an average delay of 6.6 days. The total number of National Health Care Security claim files for January- September 2018 approved firstly is 3759 files (92.36%) with the total bills approved at Rp. 1,180,532,000 (74.38%). Strategies are needed from hospital management to be able to prevent and reduce pending claims. One of them is by giving remuneration to specialists, preparation of Clinical Practice Guidelines and SOPs related to claim administration is conducted, hold periodic monitoring evaluations to monitor the claim managemant process.
Keywords: hospital, causes, pending claims, National Health Care Security
The COVID-19 pandemic has a financial impact on the State of Indonesia, so the Indonesian government must think about a strategy for financing COVID-19 patient services. Hospitals that provide COVID-19 services can submit claims to the Ministry of Health to get reimbursement for patient care costs. In its implementation, there are obstacles experienced by hospitals when submitting claims, namely the high number of dispute claims. Dispute claims are claims that after verification by BPJS Kesehatan there is a mismatch between the Hospital and BPJS Kesehatan. This study aims to determine and analyze the description of the causes of the COVID-19 claim dispute in terms of input, process, and output factors at Matraman Hospital. This research is an observational study with a qualitative approach. The research was conducted at the casemix unit of the Matraman Hospital in September-December 2020. RSUD Matraman is a government hospital with a BLUD status that self-finances the operation of the hospital, so if this claim payment is delayed, the hospital cash flow will be disrupted. The Matraman Regional Hospital has submitted 157 COVID-19 claims for the month of service from March-August 2020. The number of claims that were dispatched was 94 files (60%), more than the number of claims that passed verification of 63 files (40%). The results showed that the cause of the dispute claim that occurred at the Matraman Regional Hospital was due to the results of the swab which was not attached, the medical resume was incorrect and also not complete. Matraman Regional Hospital immediately resolves the dispute claim case so that the claim payment is immediately disbursed so that the hospital cash flow is not disturbed
