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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
Dalam menjawab keluhan perawat mengenai besarnya beban kerja di ruang rawat inap Cattleya B RSU Bhakti Yudha, perlu dilakukan analisis kebutuhan tenaga perawat dengan menggunakan beberapa formula yaitu, Workload Indicator Staff Needs (WISN), formula Gillies, PPNI, dan formula Ilyas. Penelitian dilakukan di ruang rawat inap Cattleya B menggunakan pendekatan kuantitatif dan kualitatif dengan melakukan observasi terhadap aktivitas perawat menurut metode work sampling serta in-depth interview pada 21-30 Mei 2012. Hasil penelitian menyatakan beban kerja perawat pada kategori produktif (80%) dengan hanya 33.98% yang merupakan aktivitas keperawatan langsung dan 47.4% merupakan aktivitas keperawatan tidak langsung. Penggunaan waktu untuk kegiatan pribadi dan non produktif perawatmasih di dalam standar ILO (14.98%) Formula Gillies dan PPNI, dan Ilyas tidak menggambarkan sejumlah kegiatan keperawatan tidak langsung dari perawat seperti administrasi dan pencatatan laporan, yang justru pada saat observasi membutuhkan proporsi yang lebih besar. Sebaliknya metode WISN yang menghasilkan jumlah perawat sebesar 35 orang ditambah dengan 1 kepala ruangan dianggap lebih tepat dan sesuai dengan RS karena menggambarkan beban kerja nyata. Diharapkan pihak manajemen dapat memberikan toleransi seperti pemberian hari kepelatihan bagi perawat, menambah jumlah tenaga baik perawat dan non perawat sesuai kebutuhan untuk meningkatkan mutu pelayanan.
In order to answer the concern of high workload nursing care at Cattleya B Ward of Bhakti Yudha Hospital, there is a need to analyze the requirement of nursing staff with some formulas:Workload Indicator Staff Needs (WISN), Gillies?, PPNI, and Ilyas? Formula. This Research was held in Cattleya B Ward of Bhakti Yudha Hospital on May 21st-30th 2012 using Quantitative and Qualitative approach with an observation to nursing activity based on work sampling method and also in-depth interview with some informants to gain any information for analysis. The result of this research proved that nursing workload is in productive state (80%) with only 33.98% are direct nursing care activities and 47.4% are indirect nursing care activities. The usage of time for individual activity and non-productive activity are still in the ILO Standard (14.98%) Gillies?, PPNI, and Ilyas? Formula did not described some of indirect activity like administration, and making nursing report which in observation need higher proportions than others. In the contrary, WISN, which results 35 nurses as staff with 1 additional nurse as the head of Cattleya B ward, is suitable with hospital because described the real work load in the ward. In the future, hopefully manager can give any tolerance like training day for nurse; add some staff both nursing staff and non-nursing staff as needs for service quality.
