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Since 2014 the JKN program has been running. In fact Many hospitals are not ready for information system software, and there are also hospitals had been used information systems in their hospitals, but the information system running cannot display data and information about hospital cash flow, the cliams is payed, the pending claims, the claims is not eligible to payed and diagnosis of patients who are over cost. Facing such conditions, this study proposed a dashboard information system model that could help process and display the overall hospital service activities in a one-screen display (dashboard), becoming an information needed by stakeholders. This dashboard is expected to guarantee healthy cash flow. The method used in this research was a qualitative method by using the prototyping system. The result of this research is the dashboard information system design that processes and presents data in the form of visualization in a concise and easy to understand way. The results of this information system are used to support the management of the relevant hospitals in the process of taking interventions in an effort to reduce costs.
Motor vehicle crash are the main cause of serious incident at PT X. The number of motor vehicle crash (MVC) at PT X in Sumatra operations are more than the number of other occupational incident. PT X has implemented eleven models of motor vehicle safety (MVS) policies in period 2012 to 2019. MVS performance report in 2019 shows that the trend of MVC incidents is decreasing for each year i.e., 55 incidents in 2012 to 24 incidents in 2019. The objective of the research is to determine the policies that contribute in reducing the incident during that period, as a critical point of concern to be developed. The research was conducted with a quantitative approach, using motor vehicle incident data from 2012 to 2019 with the Change Point Analysis method to find the point of change in the incident rate throughout the period 2012 to 2019. Furthermore, it is identified how to implement or change the MVS policy, whether before or after the MVC event rate change period. Finally, content analysis was carried out to determine the relationship between risk factors and MVC events in the period before or after the change period with bivariate analysis. The results showed that out of a total of 315 MVC events, one point change in the MVC incident rate was detected in January 2017, influenced by nine series of models that were completed in May 2016. The MVC rate showed a decrease of 32% (= 0.68; 95%; 0.47- 1.01). It was concluded that the Field Verification Competency policy, which was completed in May 2016, was proven to reduce the MVC incidence rate at PT X
Latar Belakang : Rawat jalan sebagai salah satu garda terdepan layanan di rumah sakit yang dituntut untuk memberikan layanan yang cepat dan berkualitas. RS. X merupakan rumah sakit swasta yang dalam pelaksanaan kegiatan usahanya sepenuhnya bergantung pada pembiayaan dari pasien pribadi dan penjaminan pihak ketiga. Semakin meningkatnya jumlah pasien rawat jalan yang menggunakan penjaminan pihak ketiga, maka tuntutan kualitas dan kecepatan pelayanan rumah sakit juga semakin tinggi. Proses verifikasi penjaminan untuk pemeriksaan penunjang di rawat jalan merupakan suatu proses di tengah alur rawat jalan untuk memastikan apakah pemeriksaan penunjang yang disarankan oleh dokter dapat dijaminkan atau tidak oleh pihak penjamin sebelum pasien melakukan pemeriksaan tersebut. Target proses verifikasi ini tercapai dalam waktu 15 menit, namun rata-rata capaian baru mencapai 66,9% dan belum memenuhi target yang ditetapkan RS. X minimal 90%.
Metode : Penelitian ini menggunakan desain penelitian operational reasearch dengan pendekatan kuantitatif dan kualitatif. Teknik pengambilan sampel secara non probability sampling dengan jumlah 90 sampel. Pemilihan sampel berdasarkan pola distribusi poliklinik, hari dan waktu.
Hasil : Pada posisi current state, rata-rata lead time proses verifikasi untuk pemeriksaan penunjang di rawat jalan RS. X 16 menit 58 detik, dimana 53,9% merupakan kegiatan non value added yang didominasi waste waiting (87,8%) dan over processing (12,2%). Dari analisis 5 Whys didapatkan akar masalah yang menyebabkan waste adalah menunggu antrian pemeriksaan berkas verifikasi, menunggu catatan medis dokter, konfirmasi biaya tindakan rehabilitas medik, konfirmasi kronologis sakit dan menunggu terhubung dengan pihak penjamin. Penerapan metode Lean menggunakan tools Standardization berhasil menurunkan lead time sebesar 23,2% yaitu menjadi 13 menit 2 detik dengan penurunan kegiatan non value added sebesar 26,2% (2 menit 24 detik).
Kesimpulan : Penerapan metode Lean berhasil menurunkan lead time dan mengurangi waste pada proses verifikasi penjaminan untuk pemeriksaan penunjang di RS. X.
Background : Outpatient service as one of the hospital’s frontline services that is required to provide fast and quality services. Hospital. X is a private hospital that in carrying out its business activities fully financially relies on private patients and third party guarantees. The increasing number of outpatients using third party guarantees, in line with the increasing of quality and speed demands of hospital services. The guarantee verification process for outpatient examinations is a process occur in the middle of the outpatient flow aim to ensure whether the examinations recommended by the doctor can be guaranteed or not by the guarantor before the patient undergoes the examination. Target for this verification process is achieved within 15 minutes, but the average achievement has only reached 66.9% and has not met the target set by the X Hospital minimum 90%. Method : This study adopted an operational research design with a quantitative and qualitative approach. The sampling technique used was non-probability sampling, with a total of 90 samples. Sample selection based on the distribution pattern of the polyclinic, day and time. Result : In the current state position, the average lead time for the verification process of supporting examinations in outpatient care at Hospital X is 16 minutes 58 seconds, where 53.9% is non-value added activities dominated by waste waiting (87.8%) and over processing (12.2%). From the 5 Whys analysis, the root cause of waste is waiting for the verification file examination queue, waiting for the doctor's medical records, confirmation of medical rehabilitation costs, confirmation of the chronology of illness and waiting to be connected with the guarantor. The application of the Lean method using the Standardization tool succeeded in reducing the lead time by 23.2% to 13 minutes 2 seconds with a decrease in non-value added activities by 26.2% (2 minutes 24 seconds). Conclusion : The implementation of the Lean method has succeeded in reducing lead time and waste in the assurance verification process for supporting examinations at X Hospital.
This study discusses the suspension of JKN claims in RS PON 2015. The purpose of this study is to analyze the problem of suspension of unpaid JKN claims in RS PON Jakarta in 2015. This study is a case study approach to analyze the causes of deferral payment of health insurance claims in RS Pusat Otak and data analysis done by doing study data obtained from primary data and secondary data then analyzed based on existing theory. Analysis to see the factors that led to the suspension of claims ranging from Coder to Management Hospital. The results showed that the suspension of claims occurred because of the large number of SEP, billing and TXT files lost in the financial / receivables thus inhibiting claims. Keywords: Claim; coder; verification; account receivable policy.
This study aims to analyze the experiences of participants and officers in the medical care verification process within the Occupational Injury Insurance Program (JKK) managed by PT ASABRI (Persero). This program is designed to provide social protection for Indonesian National Armed Forces (TNI) soldiers, National Police members, and Civil Servants (ASN) within the Ministry of Defense and the Police. A qualitative approach with a case study design was used. Data were collected through in-depth interviews with three JKK participants and three ASABRI officers directly involved in the verification process, along with a review of supporting documents. The findings reveal that the verification process includes several stages: document checking, medical data validation, and compliance evaluation with standard operating procedures (SOPs). Participants reported that the verification process is often complicated and bureaucratic, especially regarding documentation requirements and the lack of clear information. From the officers’ perspective, the main challenges include low participant literacy, lack of socialization, and limited human resources in handling complex claims. Perceptions of service quality, assessed through the SERVQUAL dimensions (tangibles, reliability, responsiveness, assurance, empathy), influence participant satisfaction levels. This study concludes that enhancing the effectiveness of the medical care verification process is essential for ensuring participant satisfaction. Recommendations include simplifying administrative procedures, improving staff training, and optimizing information systems to support the claims process. These findings are expected to serve as input for evaluating and improving policy in ASABRI’s JKK services.