Ditemukan 3 dokumen yang sesuai dengan query :: Simpan CSV
Sri Juniarti Azis; Pembimbing: Budi Hidayat; Penguji: Anhari Achadi, Atik Nurwahyuni, Dience Meidiana, Yenny Nariswari Harumansyah
Abstrak:
Pandemi COVID-19 menimbulkan dampak bagi Negara Indonesia dari sisi keuangan, sehingga pemerintah Indonesia harus memikirkan strategi pembiayaan pelayanan pasien COVID-19. Rumah sakit yang menyelenggarakan pelayanan COVID-19 dapat mengajukan klaim kepada Kementerian Kesehatan untuk mendapatkan penggantian biaya perawatan pasien. Dalam pelaksanaannya terdapat kendala yang dialami rumah sakit pada saat mengajukan klaim, yaitu jumlah dispute klaim yang tinggi. Dispute klaim merupakan klaim yang setelah dilakukan verifikasi oleh BPJS Kesehatan terdapat ketidaksesuaian antara RS dan BPJS Kesehatan. Penelitian ini bertujuan untuk mengetahui dan menganalisis gambaran penyebab dispute klaim COVID-19 ditinjau dari faktor input, proses, dan output di RSUD Matraman. Penelitian ini merupakan penelitian observasional dengan pendekatan kualitatif. Penelitian dilakukan di unit casemix RSUD Matraman pada bulan September-Desember 2020. RSUD Matraman adalah rumah sakit pemerintah yang berstatus BLUD yang membiayai sendiri operasional rumah sakitnya, sehingga jika pembayaran klaim ini tertunda maka cashflow rumah sakit akan terganggu. RSUD Matraman telah mengajukan klaim COVID-19 bulan pelayanan Maret-Agustus 2020 sebanyak 157 berkas. Jumlah klaim yang terdispute sebanyak 94 berkas (60%) lebih banyak dibandingkan jumlah klaim yang lolos verifikasi sebanyak 63 berkas (40 %). Hasil penelusuran didapatkan bahwa penyebab dispute klaim yang terjadi di RSUD Matraman disebabkan karena hasil swab yang tidak terlampir, resume medis yang tidak tepat dan juga tidak lengkap. RSUD Matraman segera menyelesaikan kasus dispute klaim yang terjadi supaya pembayaran klaim segera cair sehingga cashflow rumah sakit tidak terganggu.
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
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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
B-2163
Depok : FKM-UI, 2020
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
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Glen Locura Kanjani; Pembimbing: Kurnia Sari; Penguji: Pujiyanto, Laksmi Damaryanti
Abstrak:
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Pandemi COVID-19 menghadirkan tantangan besar bagi sistem kesehatan di seluruh dunia, termasuk di Indonesia. Rumah Sakit yang ditunjuk Kementerian Kesehatan sebagai rujukan penyelenggara pelayanan pasien COVID-19 menghadapi tekanan finansial yang besar akibat peningkatan biaya operasional sedangkan jumlah kunjungan pasien non-COVID-19 menurun. Sesuai dengan kebijakan Peraturan Menteri Kesehatan Indonesia No. 59 Tahun 2016, pembiayaan pasien Penyakit Infeksi Emerging (PIE), termasuk COVID-19, dapat diklaim ke Kementerian Kesehatan. Dalam proses klaim, sering terjadi dispute akibat ketidaksesuaian antara BPJS Kesehatan dan berkas klaim yang diajukan oleh Rumah Sakit, yang yang dapat menjadi kendala pada kelangsungan pelayanan perawatan pasien dan menghambat arus kas Rumah Sakit. Tujuan penelitian ini adalah memetakan penelitian terkait manajemen dispute klaim COVID-19 Rumah Sakit di Indonesia tahun 2020 hingga 2022 di berbagai rumah sakit di Indonesia. Penelitian ini menggunakan metode scoping review yang disajikan secara naratif, kualitatif. Pencarian artikel dilakukan melalui basis data online (Semantics dan GARUDA), situs web (Google Scholar), dan perpustakaan organisasi (Universitas Indonesia). Terdapat 15 studi yang termasuk kriteria inklusi dan eksklusi dalam penelitian ini. Hasil penelitian menunjukkan persentase klaim pasien COVID-19 yang dispute di Indonesia (52%) lebih tinggi dibandingkan klaim yang dinyatakan sesuai (48%). Penyebab dispute klaim dipetakan menurut komponen struktur, proses, dan output. Faktor man dan material merupakan elemen mendasar yang paling mempengaruhi komponen struktur. Pada komponen proses, faktor pelaksanaan menjadi kendala utama dalam eksekusi manajemen klaim. Hasil identifikasi ini menjadi dokumentasi dan pembelajaran untuk pengelolaan klaim yang lebih baik ke depan bagi rumah sakit serta lembaga terkait dalam menangani situasi pandemi di Indonesia.
The COVID-19 pandemic has posed significant challenges to healthcare systems worldwide, including in Indonesia. Designated hospitals appointed by the Ministry of Health in Indonesia to provide care for COVID-19 patients face substantial financial pressures due to increased operational costs, while the number of non-COVID-19 patient visits has declined. In accordance with the Ministry of Health Regulation No. 59 of 2016, the financing of patients with Emerging Infectious Diseases, including COVID-19, can be claimed from the Ministry of Health. However, in the claims process, disputes often arise due to inconsistencies between BPJS Kesehatan (the National Health Insurance) and the claim documents submitted by the hospitals. Disputed claims pose challenges to the continuity of patient care services and impede the hospitals' cash flow. The objective of this study is to map the research related to dispute management of COVID-19 patient claims in hospitals in Indonesia from 2020 to 2022 in hospitals across the country. This study utilizes a scoping review method presented in a narrative and qualitative manner. Article searches were conducted through online databases (Semantics and GARUDA), websites (Google Scholar), and organizational libraries (University of Indonesia). Fifteen studies met the inclusion and exclusion criteria for this research. The findings of the study indicate that the percentage of disputed COVID-19 patient claims in Indonesia (52%) is higher compared to claims that were deemed valid (48%). The causes of claim disputes were mapped according to the components of structure, process, and output. The "Man" and "Material" factors were identified as the fundamental elements that most influenced the structure component. In the process component, implementation factors emerged as the main obstacles in claims management execution. These identified results serve as documentation and a basis for learning to improve future claims management for hospitals and relevant institutions in handling the pandemic situation in Indonesia.
S-11411
Depok : FKM-UI, 2023
S1 - Skripsi Pusat Informasi Kesehatan Masyarakat
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Siti Ulfah; Pembimbing: Ede Surya Darmawan; Penguji: Wahyu Sulistiadi, Dumilah Ayuningtyas, Zulfa, Yessi
Abstrak:
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Dispute klaim COVID-19 menjadi salah satu permasalahan di Rumah Sakit Islam Ibnu Sina Bukittinggi . Klaim dispute terjadi ketika terdapat ketidak sepakatan dalam proses verifikasi BPJS Kesehatan terhadap berkas klaim rumah sakit. Klaim dispute akan berdampak terhadap penundaan pembayaran klaim COVID-19 sehingga mempengaruhi arus kas rumah sakit, dan juga proses penyelesaian klaim dispute juga membutuhkan waktu lama. Penelitian ini ditujukan untuk menganalisa penyebab terjadinya klaim dispute COVID-19 ditinjau dari faktor input, proses, output, mengidentifikasi dampak klaim dispute dan strategi bertahan rumah sakit dalam menyikapi masalah ini. Penelitian ini menggunakan pendekatan kualitatif dengan metode studi kasus. Penelitian dilakukan di Rumah Sakit Islam Ibnu Sina Bukittinggi pada bulan Juni-Juli 2021. Menggunakan data sekunder Berita Acara Hasil Verifikasi klaim COVID-19 bulan pelayanan April 2020 hingga Mei 2021. Kemudian dilanjutkan dengan melakukan wawancara mendalam dengan informan terpilih. Dari hasil penelitian, pada output terdapat klaim dispute di Rumah Sakit Islam Ibnu Sina 115 kasus sebesar Rp. 3.087.614.900 (23%). Klaim pending 62 kasus sebesar Rp. 891.426.800 (6%) . Dan ini menimbulkan dampak hingga mempengaruhi 54,7% jika dilihat dari sisi operasional rumah sakit rata-rata sebulan. Didapatkan penyebab klaim dispute dan pending terbanyak adalah penegakan diagnosa (suspek, komorbid dan koinsiden) tidak sesuai kriteria sebesar 33%, kriteria rawat inap tidak sesuai ketentuan 21%, pemeriksaan penunjang tidak sesuai kriteria 18%, kesalahan pengentrian dan upload berkas 17% dan tatalaksana tidak sesuai ketentuan 11%. Jika ditelaah lebih lanjut permasalahan terbesar adalah berasal dari faktor internal rumah sakit, penyebab dispute dan pending klaim COVID-19 ini adalah dari input terkait SDM dan kebijakan, sedangkan dari proses pengentrian dan upload berkas. Dalam menyikapi klaim dispute dibutuhkan strategi bertahan rumah sakit diantaranya adalah incresing revenue (meningkatkan pendapatan) dengan tetap mempertahankan pelayanan pasien COVID-19 yang sesuai ketentuan yang berlaku, sembari tetap memberikan pelayanan non COVID-19, cutting cost (memangkas pembiayaan) dengan mengevaluasi pembiayaan pelayanan COVID-19 saat ini
COVID-19 dispute claims is one of the problems at Islamic Hospital Ibnu Sina Bukittinggi. Dispute claims occur when there is disagreement in the BPJS Kesehatan verification process on hospital claim files. Dispute claims will have an impact on delays in payment of COVID-19 claims, which will affect the hospital's cash flow, and the settlement of disputed claims will also take longer. This study aims to determine the impact of the dispute, analyze the causes of the dispute claim in terms of input, process, output factors and the hospital's survival strategy in addressing this problem. This research uses a qualitative approach with a case study method. The study was carried out at Islamic Hospital Ibnu Sina Bukittinggi in June-July 2021. Using secondary data from the Verification Results for COVID-19 service months from April 2020 to May 2021. Then proceed with conducting in-depth interviews with selected informants. From the output data, there are claims of dispute at Islamic Hospital Ibnu Sina Bukittinggi with 115 cases of Rp. 3,087,614,900 (23%). Claims pending 62 cases of Rp. 891,426,800 (6%). And this has an impact that affects 54.7% when viewed from the side of hospital operations on average a month. From the results of the study, it was found that the causes of the most disputed and pending claims were diagnosis enforcement (suspect, comorbid and coincidental) that did not meet the criteria by 33%, the criteria for hospitalization did not comply with the provisions of 21%, supporting examinations did not meet the criteria 18%, entry errors and file uploads 17 % and the treatment is not in accordance with the provisions of 11%. If we examine further, the biggest problem is that it comes from internal hospital factors, the cause of the dispute and pending COVID-19 claims is from input related to human resources and policies, while from the process of entering and uploading files. In responding to dispute claims, hospital survival strategies are needed, including incresing revenue while maintaining COVID-19 patient services in accordance with applicable regulations, while still providing non-COVID-19 services, cutting costs by evaluating service financing. COVID-19 currently and making hospital PPK and CP related to COVID-19 services, Improving Cash Flow by evaluating the risk of claim disputes and strengthening the dispute claim settlement team so that all claims can become eligible claims from the Ministry of Health
B-2225
Depok : FKM-UI, 2021
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
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