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Medical records are an element that must be fulfilled in a hospital with a good medical record management system that will automatically improve the quality of service for both patients and hospitals. This thesis discusses what factors influence nurse compliance in returning inpatient medical record files at the Kalawa Atei Mental Hospital in 2021. Where there are 3 factors, namely individual factors, pshycology factors and organization factors. This research uses quantitative research with cross sectional method. Data in the form of secondary data obtained from medical records and primary data from questionnaires involving the entire population of nurses who served in inpatient rooms from January to February 2021. The results showed a significant relationship between age, years of service, employment status and knowledge. It is hoped that this research can be input for hospitals with the same characteristics, especially the management of the Kalawa Atei Mental Hospital in compliance with returning medical records of inpatients
Latar belakang: Ketidaklengkapan rekam medis merupakan salah satu penyebab sehingga berkas klaim sering kali tidak lengkap atau tidak tepat waktu. Banyaknya klaim yang tidak berhasil berhubungan dengan penundaan pembayaran klaim JKN oleh BPJS Kesehatan menggangu cash flow RSKD Duren Sawit. Oleh karena itu, rumah sakit perlu melakukan penelitian tentang cara pengisian lengkap rekam medis yang baik. Tujuan: Mengidentifikasi faktor-faktor yang berhubungan dengan kelengkapan dokumentasi rekam medis dan bagaimana faktor-faktor tersebut mempengaruhi proses pembayaran klaim BPJS untuk pasien yang menjalani rawat inap non jiwa di RSKD Duren Sawit dan bagaimana upaya untuk mengurangi klaim pending serta mencegah klaim pending berulang. Metode: Penelitian ini menggunakan pendekatan deskriptif analitik dengan metodologi penelitian kualitatif, dilaksanakan wawancara mendalam dengan informan yang dianggap dapat memberikan informasi yang akurat dan relevan untuk studi tersebut yang melibatkan pengumpulan dan detail dari data klaim pending yang belum terselesaikan, dibagi berdasarkan berbagai aspek masalahnya. Hasil: Penelitian ini menunjukkan bahwa tingkat kelengkapan berkas klaim BPJS pasien rawat inap di RSKD Duren Sawit cukup baik, terutama terkait identitas peserta. Namun, terdapat kelemahan signifikan dalam kesesuaian pengkodean yang memerlukan perbaikan. Penyebab utama klaim yang tertunda adalah ketidaksesuaian pengkodean dan kelengkapan hasil pemeriksaan penunjang. Ketidaklengkapan dokumen klaim dapat mengganggu arus kas rumah sakit, berpotensi mempengaruhi pembayaran gaji pegawai dan penyediaan obat-obatan. Penelitian ini merekomendasikan penguatan manajemen dan pelatihan bagi staf untuk meningkatkan kelengkapan dan akurasi berkas klaim, menekankan pentingnya peningkatan sistem dokumentasi dan pengelolaan rekam medis dalam mendukung kelancaran proses klaim BPJS.
Incomplete medical records are one of the causes of claim files often being incomplete or not submitted on time. The large number of unsuccessful claims related to the delays in payment of JKN claims by BPJS Kesehatan disrupts the cash flow of RSKD Duren Sawit. Therefore, the hospital needs to conduct research on how to properly fill out complete medical records. The objective is to identify the factors related to the completeness of medical record documentation and how these factors affect the BPJS claim payment process for patients undergoing non-psychiatric hospitalization at RSKD Duren Sawit, as well as efforts to reduce pending claims and prevent recurring pending claims. This study uses a descriptive analytical approach with qualitative research methodology, conducting in-depth interviews with informants deemed capable of providing accurate and relevant information for the study, involving the collection and details of unresolved pending claim data, categorized based on various aspects of the problems. The study shows that the completeness of BPJS claim files for inpatients at RSKD Duren Sawit is quite good, particularly regarding patient identity. However, there are significant weaknesses in coding conformity that require improvement. The main causes of pending claims are coding discrepancies and the completeness of supporting examination results. Incomplete claim documents can disrupt the hospital's cash flow, potentially affecting employee salary payments and the provision of medications. This study recommends strengthening management and training for staff to enhance the completeness and accuracy of claim files, emphasizing the importance of improving documentation systems and medical record management to support the smooth processing of BPJS claims. Keywords: Keywords: BPJS, complete claim files,pending claims, diagnosis coding, medical record
ABSTRAK Nama : Ni Wayan Sri Wahyuni Program Studi : Kajian Administrasi Rumah Sakit Judul : Ketepatan Waktu Penyelesaian Klaim Pasien Rawat Inap Jaminan Kesehatan Nasional di Rumah Sakit Ari Canti Kabupaten Gianyar Tahun 2017 Rumah Sakit Ari Canti kerap terjadi keterlambatan pengajuan klaim oleh pihak rumah sakit kepada BPJS Kesehatan yang mengganggu cash flow. Rumah sakit perlu melakukan kajian lebih lanjut melalui penelitian ini mengenai ketepatan waktu penyelesaian klaim pasien rawat inap JKN. Penelitian ini bertujuan untuk menganalisis faktor yang berpengaruh terhadap ketepatan waktu penyelesaian klaim pasien rawat inap Jaminan Kesehatan Nasional. Pendekatan yang dilakukan dengan kuantitatif dan kualitatif (mix methods) yang menggunakan desain potong lintang. Sampel berjumlah 209 dari berkas klaim dan 6 orang informan. Ketepatan waktu klaim pasien rawat inap JKN sebesar 65,4% yang tidak tepat 34,6%. Faktor – faktor yang berpegaruh secara signifikan terhadap ketepatan waktu klaim adalah ketersediaan SEP, kelengkapan berkas rekam medis, ketepatan waktu pengembalian berkas rekam medis, kesesuaian entri data berkas dan ketepatan waktu entri data. . Kata kunci: JKN, Ketepatan waktu, klaim
ABSTRACT Name : Ni Wayan Sri Wahyuni Study Programe : Hospital Administration Analysis Title : Timeliness of Claim Settlement on Inpatient Patients of National Health Insurance at Ari Canti Hospital, Gianyar District 2017 Ari Canti Hospital often happens delay in filing claims by the hospital to The Organizer of Social Health Insurance that interfere with cash flow. The hospitals need to conduct further study through this research on the timeliness of settlement of claims of inpatients of National Health Insurance. This study aims to analyze the factors that affect the accuracy of the settlement of claims of inpatients of the National Healthcare. The research using a quantitative and qualitative approach (mixed methods) with using cross sectional techniques. Research sample was 209 of claim files and six informants. The time punctuality of National Health Insurance inpatient claim’s was 65.4% and not punctual around 34.6%. Factors significantly influencing the timeliness of claims are the availability of letters of patient eligibility, medical file completeness, the timeliness of the returning the medical record, the suitability of the data entry files and the timeliness of the data entry. Keywords: National Health Insurance, timeliness, claims
Metode: Penelitian ini merupakan penelitian kuantitatif cross sectional dimana variabel bebas dan variabel terikat diukur secara bersamaan. Metode pengambilan sampel yang akan digunakan adalah teknik sampling jenuh, jadi jumlah sampel yang digunakan adalah keseluruhan jumlah populasi yaitu 80 sampel.
Result: Melalui analisis multivariate menunjukkan bahwa variabel jumlah pasien dan insentif memiliki p value masing-masing 0,009 dan 0,041, dimana p value < 0,05. Sedangkan variabel lainnya nilai p value > 0,05.
Simpulan: Hasil penelitian menunjukkan bahwa variabel-variabel yang memiliki hubungan yang signifikan terhadap tingkat kepatuhan pengisian rekam medis di Rumah Sakit Bali Royal adalah variabel jumlah pasien dan variabel insentif
Kata kunci: Tingkat Kepatuhan, Rekam Medis, Teori Lawrence Green, Teori Malcolm Baldridge
Introduction: The hospital is one of the facilities or institutions of health service providers (health providers) and in accordance with Law No. 36 of 2009 on Health. One of the conditions that are still often discussed and encountered the current obstacle is the completeness of medical records. This problem is also the attention of researchers after seeing and doing initial research at Bali Royal Hospital. It was found that the completeness of the medical record at Bali Royal Hospital Inpatient Unit is still below the standard set by Ministry of Health stated in Kepmenkes RI No.129 / MENKES / SK / II / 2008 which is 100%. The completeness of medical records for inpatients is crucial to the patient's healing process and maximizing hospital services to patients. Where the level of compliance of doctors in filling out medical records at RS BROS still not reached the target of the hospital that is 90%
Method: This research is a cross sectional quantitative research where independent variable and dependent variable are measured simultaneously. Sampling method to be used is a saturated sampling technique, so the number of samples used is the total population of 80 samples.
Results: Through multivariate analysis showed that the variable number of patients and incentives had p values of 0.009 and 0.041, respectively, where p value 0,05.
Conclusion: The results showed that the variables that have a significant relationship to the compliance level of medical record at Bali Royal Hospital are variable of patient number and incentive variable
Keywords: Compliance Level, Medical Record, Lawrence Green Theory, Malcolm Baldridge Theory
ABSTRAK Nama : Ni Wayan Kesumawati Program Studi : Kajian Administrasi Rumah Sakit Judul : Analisis Piutang Pada Pasien Rawat Inap Jaminan Kesehatan di Rumah Sakit Umum Famili Husada Periode 2015-2016 Pergeseran skema pembayaran biaya kesehatan ke rumah sakit telah bergeser dari majoritas biaya sendiri dibayar tunai ke pembayaran melalui pihak penyelenggara jaminan kesehatan, yang menyebabkan rumah sakit harus mengelola piutang dengan baik karena penerimaan pendapatan rumah sakit dibayar non-tunai. Keterlambatan pembayaran piutang dan atau kegagalan pengelolaan piutang dapat mempengaruhi posisi arus kas, yang kalau ini berlanjut mengakibatkan terganggunya kegiatan operasional rumah sakit. Tujuan penelitian ini untuk mengetahui posisi gambaran piutang pada pasien jaminan kesehatan di RSU Famili Husada periode tahun 2015 – 2016 dimana rumah sakit telah memutuskan untuk melayani pasien BPJS Kesehatan. Selain itu perlu juga diketahui jumlah piutang dan kebijakan pemberian kredit yang ada agar dapat dijadikan masukan untuk perbaikan manajemen kedepan. Penelitian ini menggunakan metode penelitian deskriptif kualitatif dengan melibatkan seluruh pegawai yang bekerja di bagian keuangan, kasir, front office dan manajemen, sebanyak 14 orang sebagai informan. Data dikumpulkan dengan teknik wawancara mendalam dan observasi partisipan, kemudian dianalisis menggunakan content analysis. Hasilnya menunjukkan bahwa terdapat peningkatan saldo piutang pasien rawat inap pasien jaminan kesehatan pada tahun 2015 – 2016 terutama untuk pasien JKN yaitu dari sebasar 17% meningkat menjadi 30,66%, sedangkan rata – rata persentase pembayaran piutangnya sebesar 45% yang artinya pembayaran piutang dari pasien BPJS Kesehatan belum lancar sehingga bila ini tidak dikelola dengan baik akan menimbulkan terganggunya arus kas dan akhirnya kegiatan opreasional rumah sakit pun terganggu. Kesimpulan yang dapat diambil bahwa seiring dengan terjadinya peningkatan jumlah piutang rumah sakit terdapat ketebatasan secara kuantitas maupun kualitas dari sumber daya manusia dalam pengelolaan piutang; belum ada standar prosedur operasional yang mengatur secara khusus tentang pemberian kredit dan kebijakan pengumpulan piutang. Berdasarkan hasil penelitian ini, disarankan agar melakukan evaluasi terhadap kebijakan pemberian kredit dan penagihan piutang yang berlaku, evaluasi beban kerja petugas pengelola piutang dan lakukan pelatihan – pelatihan khusus di bidangnya, serta lakukan pendekatan pada pihak debitur. Kata Kunci: Jaminan Kesehatan, Piutang
ABSTRACT Name : Ni Wayan Kesumawati Study Program : Hospital Administration Title : Accounts Receivable Analysis In Inpatient Patients Health Insurance at Famili Husada Public Hospital Period 2015-2016 The shift in health-care payment schemes to hospitals has shifted from the majorities of their own expenses paid in cash to payments through health insurance providers, which causes hospitals to manage receivables well because hospital revenue is paid non-cash. Delinquent receivables and / or failure of receivables management may affect cash flow position, which if this continues to result in disruption of hospital operations. The purpose of this study is to know the position of the description of receivables in health insurance patients at RSU Famili Husada period 2015 - 2016 where the hospital has decided to serve the patient BPJS Health. In addition, it is also necessary to know the amount of receivables and lending policies available to be used as input for future management improvement. This research uses qualitative descriptive research method by involving all employees who work in finance, cashier, front office and management, as many as 14 people as informant. Data were collected by in-depth interview technique and participant observation, then analyzed using content analysis. The results show that there is an increase in the balance of accounts receivable of patient in health care patient in 2015 - 2016 especially for JKN patient that is from sebasar 17% increase to 30,66%, whereas the average of payment percentage of receivable equal to 45% which mean payment of receivable from patient BPJS Health has not been smoothly so that if it is not managed properly will cause disruption of cash flow and finally hospital operational activities were disrupted. The conclusion can be made that in line with the increase of the number of hospital receivables there are limitations in quantity and quality of human resources in the management of receivables; there is no standard operating procedure that specifically regulates the provision of credit and collection policy of receivables. Based on the result of this research, it is suggested to evaluate the crediting policy and receivable billing, evaluation of workload of receivable management officer and do special training in the field, and approach the debtor. Keywords: Health Insurance, Accounts Receivable