Ditemukan 33877 dokumen yang sesuai dengan query :: Simpan CSV
This study discusses the suspension of JKN claims in RS PON 2015. The purpose of this study is to analyze the problem of suspension of unpaid JKN claims in RS PON Jakarta in 2015. This study is a case study approach to analyze the causes of deferral payment of health insurance claims in RS Pusat Otak and data analysis done by doing study data obtained from primary data and secondary data then analyzed based on existing theory. Analysis to see the factors that led to the suspension of claims ranging from Coder to Management Hospital. The results showed that the suspension of claims occurred because of the large number of SEP, billing and TXT files lost in the financial / receivables thus inhibiting claims. Keywords: Claim; coder; verification; account receivable policy.
Kata Kunci: Lean Thinking, BPJS, klaim, value added activity, non value addedactivity, waste
Delay in the submission of BPJS claims resulted in decreasing hospital cash flow. The currentclaim process is not efficient and effective.The objective of this reseach is to analize and proposeimprovement in the claim process by applying Lean Hospital concept. This research usedquantitative and qualitative approaches to observed the time required to complete the claimprocess before submitted to the BPJS verificator and also have an in-depth interview, observe theprocess, and document review. The result showed most waste happened in mobilisasi dana unitfor 32.5 days 18.8 minutes in the settlement BPJS document claims. Based on Value StreamMapping, Lead Time of the claim process at this time is 33.9 day. Most types of waste arewaiting and transportation. Proposed improvement provided from the study is to optimizing thecasemix team which newly formed. By optimizing the casemix team, Lead Time required tocomplete the claims process is 6.44 minutes. Standardize work and performance appraisal (KPI,IKI, and IKU) consider to apply to reach employee best performance.
Keywords: Lean Thinking, BPJS, claim, value added activity, non value added activity, waste
ABSTRAK Nama : Weny Rinawati Program Studi : Kajian Administrasi Rumah Sakit Judul : Analisis biaya perawatan stroke berdasarkan Clinical Pathway di Rumah Sakit Pusat Otak Nasional Jakarta dalam pelayanan pasien Jaminan Kesehatan Nasional Latar belakang. Masalah yang sering dihadapi pada pelayanan pasien Jaminan Kesehatan Nasional adalah kesenjangan biaya perawatan pasien stroke dengan tarif INA-CBGs. Hal ini terkait dengan biaya perawatan dan Clinical Pathway. Tujuan. Mengetahui biaya perawatan pasien stroke di Rumah Sakit Pusat Otak Nasional. Metoda. Penelitian kuantitatif deskriptif mengikutsertakan 277 subjek penyakit stroke yang diperoleh di Rumah Sakit Pusat Otak Nasional Jakarta selama Januari – Juni 2015. Biaya perawatan stroke dihitung berdasarkan biaya satuan (unit cost) dengan menggunakan metode activity based costing dan Clinical Pathway. Hasil. Biaya satuan perawatan stroke iskemik dan stroke hemoragik berdasarkan Clinical Pathway, dengan memperhitungkan biaya investasi dan biaya gaji, tanpa memperhitungkan jasa medis berturut-turut adalah Rp 311,860,860.83 dan Rp 585,083,610.01; dengan memperhitungkan biaya investasi, biaya gaji, dan jasa medis berdasarkan tarif rumah sakit adalah Rp 321,682,940.73 dan Rp598,929,450.01; dengan memperhitungkan biaya investasi, biaya gaji, dan jasa medis berdasarkan tarif IDI adalah Rp 318,360,860.73 dan Rp 594,333,610.01; tanpa memperhitungkan biaya investasi, biaya gaji, dan jasa medis adalah Rp30,361,681.00 dan Rp25,698,199.46; tanpa memperhitungkan biaya investasi dan biaya gaji, tetapi memperhitungkan jasa medis berdasarkan tarif rumah sakit adalah Rp 40,183,761.00 dan Rp 39,544,199.46; tanpa memperhitungkan biaya investasi dan biaya gaji, tetapi memperhitungkan jasa medis berdasarkan IDI adalah Rp 36,861,681.00 dan Rp 34,948,199.46. Simpulan: Dijumpai selisih biaya perawatan berdasarkan biaya satuan dan Clinical Pathway, baik yang memperhitungkan biaya investasi, gaji, dan jasa medis, maupun tanpa memperhitungkan biaya investasi, gaji, dan jasa medis, dengan tarif layanan existing dan tarif INA-CBGs Kata kunci : biaya, Clinical Pathway, INA-CBGs, stroke
ABSTRACT Name : Weny Rinawati Study Program : Hospital Administration Title : Cost of stroke treatment based on Clinical Pathway in National Brain Center Hospital, Jakarta Background. Problem often encountered in patient care National Health Insurance is the gap between the cost of stroke treatment with INA-CBGs tariff. This is related to the cost of treatment and the Clinical Pathway. Aim. Knowing the cost of stroke treatment in the National Brain Center Hospital Jakarta. Methods. Descriptive quantitative study involving 277 subjects stroke obtained at the National Brain Center Hospital Jakarta during January - June 2015. The cost of stroke treatment are calculated based on the unit cost using activity-based costing method and Clinical Pathway. Results. The unit cost of ischemic stroke and hemorrhagic stroke treatment by Clinical Pathway, taking into account investment costs and salary costs, regardless of medical services is IDR 311,860,860.83 and IDR 585,083,610.01; taking into account investment cost, salary cost, and medical services tariff based hospital is IDR 321,682,940.73 and IDR 598,929,450.01; taking into account investment cost, salary cost, and medical services tariff based IDI is IDR 318,360,860.73 and IDR 594,333,610.01; without taking into account investment cost, salary cost, and medical services are IDR 30,361,681.00 and IDR 25,698,199.46; without taking into account the investment cost and salary cost, but taking into account medical services tariff based hospital is IDR 40,183,761.00 and IDR 39,544,199.46; without taking into account the investment cost and salary cost, but taking into account medical services tariff based IDI is IDR 36,861,681.00 and IDR 34,948,199.46. Conclusion. Found difference in the cost of stroke treatment is based on unit cost and Clinical Pathway, both of which take into account the investment, salaries, and medical services cost, and without taking into account investment, salaries, and medical services cost, with existing services and tariff rates INA-CBGs Keywords: Clinical Pathway, cost, INA-CBGs, stroke
ABSTRAK Nama : Imas Rahmi Wisdiani Program Studi : Kajian Adminstrasi Rumah Sakit Judul Tesis : Analisis Implikasi Sistem Pembayaran JKN terhadap Pendapatan Rumah Sakit di Dua Rumah Sakit Swasta Kelas C di Karawang Tahun 2017 (Studi Kasus Herniotomi Tanpa Penyulit) Besaran tarif yang diatur dalam INA-CBG mendorong rumah sakit untuk menciptakan berbagai macam upaya khususnya berupa usaha pengendalian biaya agar tercipta efisiensi yang baik dan mutu pelayanan kesehatan tetap berkualitas. Penelitian ini bertujuan untuk menganalisis implikasi system pembayaran JKN terhadap pendapatan rumah sakit di dua rumah sakit swasta kelas C berdasarkan tarif BPJS dan tarif rumah sakit. Desain penelitian ini berupa studi kasus di dua rumah sakit swasta kelas C dengan desain potong lintang dan melihat tren yang terjadi pada periode tahun 2014 – 2016. Pengumpulan data dilakukan dalam dua bagian, analisis kuantitatif bertujuan untuk menganalisis selisih pendapatan berdasarkan tarif BPJS dan tarif rumah sakit dan menganalisis komponen-komponen yang menentukan besaran tarif rumah sakit. Analisis kualitatif bertujuan untuk mendapatkan informasi kebijakan-kebijakan dan upaya-upaya yang dilakukan oleh pihak manajemen rumah sakit dalam merespon selisih biaya. Penelitian dilakukan pada bulan Mei – Juni 2017 di RS A dan RS B dengan karakteristik rumah sakit yang mirip dan bekerjasama dengan BPJS sejak tahun 2014. Terdapat selisih negatif antara pendapatan berdasarkan tarif umum dengan pendapatan berdasarkan tarif BPJS pada periode tahun 2014 – 2016 baik di RS A maupun di RS B. Selisih negative di RS A sebesar 21,2% dari nilai pendapatan berdasarkan tarif umum, dan selisih negative di RS B sebesar 50,5% dari nilai pendapatan berdasarkan tarif umum. Besaran tarif dan metode pembayaran INACBGs menyebabkan adanya upaya-upaya efisiensi dan kendali biaya rumah sakit bagi pasien BPJS berupa pembayaran jasa medis yang lebih rendah, penggunaan obat generik, pengendalian pemeriksaan penunjang, pengendalian biaya di ruang operasi serta pengendalian jumlah hari rawat. Kata kunci : pembayaran JKN, pendapatan Rumas sakit, Rumah Sakit swasta,
ABSTRACT Nama : Imas Rahmi Wisdiani Program Studi : Hospital Administration Judul Tesis : Analysis on JKN Payment System and its relation to Hospital Income in two type C private hospitals in Karawang, 2017 The implementation of payment system using INA-CBGs (bundling) has lead hospital to improve efficiency to provide good quality of care. The purpose of this study is to analyze implication of JKN payment system toward hospital revenue in two type C private hospitals. This case study in two type C private hospitals was done using Cross Sectional design. Data was retrospectively collected to capture trend for period 20142016,and analysed to compare hospital revenue using hospital charge vs BPJS payment scheme as set up by BPJS. The study was conducted in May-June 2017 covering 548 cases with Herniotomy in the two private hospitals with similar characteristics and contracted as BPJS service provider since 2014. The study revealed that both hospitals tend to have lower revenue from BPJS using bundling scheme as compared to hospital charge, for period 2014-2016. The result showed that in hospital A 21,2% loss and in hospital B was 50,5% loss, this may caused by unefficient use of resources, or no proper monitoring system. The two hospitals have tried to improved efficiency, implement cost containment such as fee adjustment, use of generic drug, proper length of stay, cost containment in providing medical exam and operation. Key words: JKN payment, private hospital, revenue
JKN era has become a national issue for the State Indonesia since long time .Hospital as a health care provider must immediately improve itself . By changingthe scheme of payment of fees for services became Case -based group requireshospitals to apply efficient use of resources such as drugs and medical proceduresand medical support . Siloam Hospitals Balikpapan has difference in billingtherefore conducted an analysis of the factors that the financial adverse by themethod of comparison on clinical pathways and qualitative methods to informant .It was found that the existing clinical pathways have not become a controllingquality and costs . So it should be a review of the use of clinical pathways becauseit takes control of cost and quality in health care in special hospitals hospitals withCase payment scheme based group.Key words :JKN , Clinical Pathway , Tariff , Eficiency