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This thesis discusses the analysis of BPJS K inpatient claim late claims in traffic accident cases at the Karima Utama Surakarta hospital in 2020. The purpose of this study is to determine the input factors and process factors that influence the delay in the BPJS claim submission process Health in the case of a traffic accident at the special hospital operating in Karima Utama Surakarta. This research is an analytic study with a qualitative approach and observation. From the research it was found that there were still delays in the BPJS K inpatient claims for traffic accident cases with a duration of 2- 29 days. Delays occur at the data input stage in the traffic accident guarantee application by officers both hospital staff, police and jasa raharja. Delay also occurs in the phase of coding that is the completeness of the patient's medical history and resume. The results of the study suggest improvement in the human factor, namely improving the quality of human resources, method factors by making hospital regulations as a reference for officers in carrying out their duties and responsibilities, increasing supervision from the leadership as well as providing guidance to staff and increasing coordination between the hospital and the police, jasa raharja and BPJS Kesehatan. It is expected that the DPJP is also orderly in filling out medical records and proposals to increase medical records quality with electronic medical records.
Penelitian ini dilatar belakangi oleh kenyataan bahwa telah terjadi pergeseran terhadap pola pembayaran pengguna jasa Rumah Sakit, dari membiayai sendiri menjadi menggunakan pihak ketiga yaitu Asuransi Kesehatan dan banyaknya kendala yang dihadapi dalam menjalin kerjasama dengan PT Askes terutama pada keterlambatan dokumen klaim. Keterlambatan ini berdampak pada berkurangnya target pendapatan rumah sakit untuk disetorkan pada kas daerah pada akhir tahun anggaran. RSUD Dr. Adjidarmo adalah Rumah Sakit type C dengan kapasitas 120 tempat tidur, terletak dipusat kota Rangkasbitung, Kabupaten Lebak Provinsi Banten. Pada penelitian ini, peneliti melakukan analisis faktor-faktor input yaitu SDM, dana. material, dan metode dengan keterlambatan dokumen klaim Askes melalui proses tahapan manajemen piutang. Penelitian ini merupakan penelitian kualitatif dengan metode deskriptif analitik yaitu melalukan pengamatan langsung pads PPATRS (Program Pelayanan Administrasi Terpadu Rumah Sakit), wawancara mendalam dan telaah dokumen pada sistem manajemen Rumah Sakit. Penelitian ini dilakukan dilingkungan RSUD Dr. Adjidarmo dan Asissten Area Manager (AAM) PT. Askes cabang Lebak dari bulan Februari sampai dengan bulan April 2006 dengan menggunakan data rekapitulasi keterlambatan dokumen klaim tahun 2005. Hasil dan pembahasan dari penelitian ini dibagi menjadi 3 (tiga) bagian yaitu input, proses dan output sesuai dengan kerangka konsep pada metodologi penelitian. Pada pembahasan diungkapkan basil penelitian yang didapat, dibandingkan dengan teori, dengan paneliti terdahulu serta judgement dari peneliti. Kesimpulan dari penelitian ini yaitu adanya keterlambatan yang sangat bermakna pada penyelesaian dokumen klaim obat rawat jalan dan rawat imp, dimana kendalanya terdapat pads tahap pembebanan dan penataan dari unsur SDM, material dan metode. Kendala tersebut berupa kurangnya tenaga pelaksana untuk penyelesaian klaim obat rawat imp dan rawat jalan, kurangnya sarana penunjang dan belum adanya kerjasama yang baik diantara unit terkait. Tidak adanya kepastian tugas, tanggungjawab dan wewenang pada petugas penatalaksana klaim obat merupakan kendala yang cukup berarti. Dengan dibentuknya Tim Pengendali Askes, diharapkan kendala-kendala tersebut dapat diatasi.
The background of this study was based on fact that have frictioned to pattern payment of Hospital service client, from out pocket became to Health Insurance as the third party and many problem faced in braiding cooperation with PT Askes especially at claim document delayed. This delay affect in decreasing hospital targets budget at end of the year. RSUD Dr. Adjidarmo was a type C hospital with 120 beds where located in Rangkasbitung downtown, Sub-Province Lebak Province Banter'. In this research, researcher made analysis of input factors that were man, money, material, and method with delay in claim document Askes through receivable management step process. This research was qualitative research with analytic descriptive method by doing direct observation at PPATRS (Intire Program Administrative Services of Hospital), in-depth interviews and document study at Hospital management system. This Research was done in RSUD Dr Adjidarmo environment and Asissten Area Manager (AAM) PT. Askes branch Lebak from Februari up to April 2006 and used back up data of 2005. The result and discussion from this research were divided in three parts, that were input, process and output according to framework concept at research methodology. The result compared with theory, previous researcher and also judgment from researcher. Conclusion of this research was delay in drug claim document of out-patient and in-patient where the problem came from in house phase and billing phase, and from variable of human resources, material and method. The problems were lack of employees, especially in drug claim, lack of supporter medium and there was no good cooperation among related units. Inexistence certainty of duty, authority and responsibility was a meaningfull enough problem. By forming of Askes Controller Team, expected the problem could be resolved.