Ditemukan 5 dokumen yang sesuai dengan query :: Simpan CSV
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.
ABSTRAK Nama : Juanna Soehardy Program Studi : Kajian Administrasi Rumah Sakit Judul Tesis : Analisis KesiapanRumah Sakit Budi Kemuliaan dalam Perubahan sebagai Fasilitas Kesehatan Tingkat Lanjut Jaminan Kesehatan Nasional. Untuk melihat kesiapanRumah Sakit Budi Kemuliaan dalam Perubahan sebagai Fasilitas Kesehatan Tingkat Lanjut (FKTL) Jaminan Kesehatan Nasional(JKN), maka peneliti mengadakan penelitian dengan analisis kualitatif dari tahun 20142016. Dilakukan wawancara mendalam dengan 8 informan yaitu : Pemilik Rumah Sakit Budi Kemuliaan, Direktur, Wakil Direktur, Ketua Komite Medik, Ketua Tim Pengendali Jaminan Kesehatan Nasional, Kepala Unit MPKR Badan Penyelenggara Jaminan Sosial Kesehatan Cabang Batam dan verifikator Badan Penyelenggara Jaminan Sosial Kesehatan. Selain itu dilakukan telaah dokumen yang relevan mengenai kesiapan organisasi, kesiapan sistem Administrasi, kesiapan Manajemen Keuangan, dan kesiapan manajemen Medis. Penelitian ini menemukan Rumah Sakit Budi Kemuliaan sudah melakukan beberapa kesiapan, yaitu : kesiapan organisasi (Keputusan Direksi, terbentuk Tim Pengendali Jaminan Kesehatan Nasional), kesiapan administrasi (Persyaratan menjadi FKTL dari Badan Penyelenggara Jaminan Sosial), kesiapan manajemen keuangan (Sistem Tarif INA-CBG’s, keterlambatan klaim ke BPJS, Klaim yang direvisi, Pembayaran Jasa Medis Dokter), kesiapan manajemen medis (Penyusunan clinical pathway), dan yang masih perlu dilakukan yaitu pengurusan akreditasi baru, pengiriman klaim yang tepat waktu serta pengisian klaim yang tepat waktu, menyusun clinical pathway Staf Medik Fungsional Penyakit Dalam, Staf Medik Fungsional Anak, Staf Medik Fungsional Mata , Staf Medik Fungsional Saraf. Penelitian ini mengusulkan adanya kebijakan dari Direksi mengenai dokter-dokter harus mau mengisi resume medis tepat waktu, membuat diagnosa yang tepat, menyusun clinical pathway, adanya Sistem Informasi Manajemen Rumah Sakit yang terintegrasi, mengurus akreditasi baru versi 2012. Kata kunci : Keterlambatan klaim, Klaim yang direvisi, clinical pathway.
ABSTRACT Name : Juanna Soehardy Study Programe : Hospital Administration Public Health Faculty University of Indonesia Thesis Title : Readiness Analysis Hospital Budi Kemuliaan in changes as anAdvanced Health Facilities National Health Insurance To see the readiness Hospital Budi Kemuliaan in the Amendment as Advanced Health Facilities National Health Insurance, the researchers conducted research with a qualitative analysis of the years 2014-2016. Conducted in-depth interviews with eight informants: Own Hospital Budi Kemuliaan, Director, Deputy Director, Chairman of the Medical Committee, Chairman of the National Health Security Control Team, Head of Unit MPKR Social Security Agency and Health Branch Batam verifier Social Security Agency of Health. Additionally conducted study of relevant documents concerning the readiness of the organization, system readiness Administration, Financial Management preparedness and readiness of medical management. This study found the Hospital Budi Kemuliaan already done some preparation, namely: the readiness of the organization (Decision of the Board of Directors, formed Control Team National Health Insurance), the readiness of administration (Conditions become FKTL of BPJS), readiness of financial management (System Rates INA-CBG's, delay claims to BPJS, claims revised, Payment Services medical Doctor), readiness of medical management (preparation of clinical pathways), and that still needs to be done, namely the maintenance of a new accreditation, sending claims on time and charging claims timely, compiling clinical pathways SMF Disease , SMF Child, Eyes SMF, SMF Neuroscience. This study proposes a policy of the Board of Directors of the doctors have to fill in a timely medical resume, make a proper diagnosis, compiling clinical pathways, their SIMRS integrated, the new 2012 version takes care accreditation. Keywords: Delay claims, claims revises, clinical pathway
ABSTRAK
Nama
: Muhamad Rezaldi
Program Studi : Kajian Administrasi Rumah Sakit
Judul
: Analisis Faktor Penentu Keterlambatan Klaim INA CBG’s Pasien
Rawat Inap di RSIA Murni Asih Kabupaten Tangerang pada Januari
2018
Pembimbing : DR. dr. Sandi Iljanto, MPH.
Latar Belakang: Jaminan Kesehatan Nasional (JKN) melalui Badan Penyelenggara
Jaminan Sosial (BPJS) Kesehatan sebagai pemberi perlindungan sosial menuntut rumah
sakit untuk memberikan pelayanan bermutu dan berkualitas kepada peserta BPJS
Kesehatan. Dalam menjalankan fungsi rumah sakit untuk memberikan pelayanan kepada
peserta BPJS Kesehatan, maka rumah sakit perlu melakukan klaim dana kepada pihak
BJPS Kesehatan sesuai diagnosa yang sudah ditetapkan Indonesian Case-Based Groups
(INA CBG’s). Klaim biaya tersebut digunakan sebagai pengganti dari biaya yang sudah
dikeluarkan rumah sakit dalam menjalankan pelayanan kesehatannya kepada peserta
BPJS Kesehatan. Namun pada kenyataannya masih banyak berkas-berkas yang ditunda
ataupun ditolak BPJS sehingga rumah sakit tidak mendapatkan klaim tersebut. Penundaan
dan atau penolakan klaim disebabkan karenan tidak lolosnya berkas-berkas melalui
verifikator BPJS Kesehatan. Dengan diberlalukannya system Vedika (Verifikasi di
Kantor) ada beberapa perubahan kebijakan pada proses klaim berkas INA CBG’s yang
membuat rumah sakit dituntu untuk bisa beradaptasi.
Tujuan: Mengetahui faktor-faktor penentu keterlambatan klaim INA CBG’s BPJS
Kesehatan berdasarkan beberapa variabel yang sudah ditentukan sebelumnya dan
dimodifikasi oleh peneliti.
Metode: Penelitian ini bersifat deskriptif analitik dengan pendekatan kuantitatif.
Pengumpulan data dilakukan kepada berkas-berkas klaim INA CBG’s yang akan
diajukan ke BPJS Kesehatan dari pasien rawat inap. Data yang dikumpulkan dimasukkan
ke dalam checklist kuesioner yang kemudian akan diolah hasilnya.
Hasil: Dari 8 variabel independent yang diuji, variabel Ketepatan Pengisian Resume
Medis Koding Diagnosa Sekunder memiliki peran paling penting menyebabkan berkas
klaim tertunda. Koding Diagnosa Sekunder juga berhubungan dengan Variabel
Independent Severity Level atau tingkat keparahan penyakit yang bisa mempengaruhi
kelayakan berkas klaim.
Kesimpulan: Saat ini, aspek dan kaidah koding berperan penting dalam kelayakan berkas
klaim INA CBG’s, sehingga rumah sakit harus terus belajar dan mencari tahu apa saja
yang baik untuk diinputasi dalam nenentukan koding yang tepat, sehingga berkas klaim
dapat terbayarkan tepat waktu tanpa ditunda.
(kata kunci: INA CBG’s, klaim BPJS, verifikator BPJS, Vedika)
ABSTRACT Name : Muhamad Rezaldi Study Program : Kajian Administrasi Rumah Sakit Title : Analisis Faktor Penentu Keterlambatan Klaim INA CBG’s Pasien Rawat Inap di RSIA Murni Asih Kabupaten Tangerang pada Januari 2018 Counsellor : DR. dr. Sandi Iljanto, MPH. Background: National Health Insurance (JKN) through the provider of Social Security Administering Agency (BPJS) Health as a social protection provider requires the hospital to provide quality and quality services to BPJS Kesehatan participants. In performing the function of the hospital to provide services to participants BPJS, eating hospital needs to make claims of funds to the BJPS Kesehatan according to the diagnosis set by Indonesian Case-Based Groups (INA CBG’s). Claim fees are used in lieu of the costs already incurred hospital in running health services to participants BPJS Kesehatan. But infact there are still many files that are postponed or rejected by BPJS Kesehatan so that the hospital does not get the claim. Delays and or rejection of claims are caused due to not passing the files through BPJS Kesehatan verifier. With the implementation of The Vedika (Verification in the Office) there were several policy changes to the claim process of INA CBG's file which made the hospital to be able to adapt. Purpose: Find out the determinants of the delay in INA CBG's BPJS Kesehatan claims based on some predefined variables which has been predetermined and modified by the researcher. Method: This research is analytical descriptive with quantitative approach. The data collection is done to the claims file of INA CBG’s that will be submitted to BPJS Kesehatan of inpatients. The data collected is included in the checklist of questionnaires which will then be processed. Result: Of the 8 independent variables tested, the Adjustment Resume Filling variable Medical Coding Secondary Diagnosis has an important role causing the tertunda claim. Secondary Diagnostic coding is also associated with the Severity Level variable that may affect the eligibility of the claim. Conclusion: Currently, coding aspects and rules play an important role in the feasibility of INA CBG's claim, so hospitals must continue to learn and find out what is good to input in determining proper coding so that claims files can be paid on time without delay. (key words: INA CBG’s, Claim BPJS, Verifikator BPJS, Vedika).
RSUD Tanjung Uban experience delays in claims submission of UHCparticipants to BPJS approximately 32 days from the deadline that been regulated withPMK 28 tahun 2014. The aim of this research is to evaluate the claims delay. Thisresearch use qualitative with methode in-depth interviews and documents review.The results indicate that the delay claims due to a lack of coordination,understanding socialization of UHC patient service regulations so there is a differencein diagnosis and make the claim requirement complience takes a long time. Theres a lackof human resources with skill especially supported with lack of information system andpower supply disruption that often occur make a disruption of hospital operationalmanagement service.The conclusion is necessary to increase communication, coordination,socialization with BPJS. Hospital need human resources needs analysis, increasing inclaim management, operational control of information systems and supply sufficientelectricity to expedite claims.Key Word : UHC, Claim handling, Acurate and timely