Tinjauan Trend Penyebab Pending Claim Jaminan Kesehatan Nasional Rawat Inap di RSUD Ciamis

Fahreza, Salma Aulia (2024) Tinjauan Trend Penyebab Pending Claim Jaminan Kesehatan Nasional Rawat Inap di RSUD Ciamis. Diploma thesis, Politeknik Kesehatan Kemenkes Tasikmalaya.

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Abstract

REVIEW OF THE TREND OF CAUSES OF PENDING CLAIMS IN NATIONAL HEALTH INSURANCE FOR INPATIENT CARE AT CIAMIS HOSPITAL 52 Pages, 5 Chapters, 2 Tables, 8 Figures, 22 Appendices ABSTRACT Background: The National Health Insurance (JKN) program in Indonesia aims to provide comprehensive health insurance certainty for the population. In the context of its implementation in hospitals, specific management is required. Health financing is obtained through claims to the Social Security Agency for Health (BPJS Kesehatan), involving the process of claim submission and verification. Incomplete or non-compliant claims can result in pending claims, affecting cash flow and health services. This research explores the trend of causes of pending claims at Ciamis Regional General Hospital in the context of inpatient JKN implementation. By understanding these causes and trends, it is expected to identify solutions to improve the efficiency and sustainability of the JKN program. Methodology: This type of research is mixed method with a sequential explanatory model. The subjects in this research were three medical records officers and data on pending JKN claims for 2023. Data collection methods were through observation and interviews using observation sheets, interview guides, and calculators to calculate the number of pending files based on administrative aspects, medical aspects, and coding aspects. . Results: The causes of pending claims occur due to administrative aspects, medical aspects, and coding aspects. At Ciamis Regional Hospital, most cases are due to coding problems, namely errors in coding diseases and actions. Communication between teams is regularly established to prevent errors. Conclusion: The factors causing pending claims are administrative aspects, medical aspects, and coding aspects. Most pending errors are due to the coding aspect. There is no specific SPO regarding the claims process Keywords: BPJS Kesehatan, JKN, pending claims References: 34 (2004-2023)

Item Type: Thesis (Diploma)
Uncontrolled Keywords: BPJS Kesehatan, JKN, pending claim
Subjects: H Social Sciences > HA Statistics
Depositing User: Mhs Salma Aulia Fahreza
Date Deposited: 15 Aug 2024 06:04
Last Modified: 16 Oct 2024 04:27
URI: http://repo.poltekkestasikmalaya.ac.id/id/eprint/4657

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