NISRIINAA, NISRIINAA (2025) Analisis Faktor-Faktor yang Mempengaruhi Terjadinya Klaim Pending di Instalasi Rawat Inap RSUD Prof. Dr. Margono soekarjo Purwokerto Tahun 2024. Diploma thesis, Politeknik Kesehatan Tasikmalaya.
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Text (LEMBAR PENGESAHAN)
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Text (BAB I PENDAHULUAN)
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Abstract
ABSTRAK Latar Belakang: Proses klaim JKN merupakan elemen krusial dalam pembayaran layanan kesehatan, namun sering menghadapi masalah klaim pending yang dapat berdampak serius pada arus kas rumah sakit, termasuk keterlambatan pembayaran jasa medis dan terganggunya operasional layanan kesehatan. RSUD Prof. Dr. Margono Soekarjo, sebagai rumah sakit rujukan regional, mencatat 8,05% klaim pending dari total 25.281 SEP pada periode Januari–Juni 2024. Tingginya persentase ini menunjukkan urgensi untuk menganalisis faktor-faktor penyebab klaim pending, seperti ketidakakuratan koding, ketidaklengkapan dokumen medis, dan kesalahan administrasi. Metode Penelitian: Penelitian kuantitatif dengan desain deskriptif korelasional dan pendekatan cross-sectional. Populasi penelitian meliputi 25.281 data klaim dengan sampel sebanyak 394 data klaim. Hasil Penelitian: Hasil analisis univariat menunjukkan bahwa 87,3% klaim masih berstatus pending. penyebab utama berasal dari faktor medis (76,5%), diikuti faktor koding (21,5%), dan faktor administrasi (2%). Kesalahan kodifikasi diagnosis (75,7%) dan ketidaksesuaian indikasi rawat inap (63,1%) menjadi penyebab dominan dalam masing-masing kategori. Analisis bivariat menggunakan uji ChiSquare menunjukkan bahwa terdapat hubungan signifikan antara pending klaim dengan faktor koding (p < 0,001) dan faktor medis (p < 0,001), namun tidak ditemukan hubungan signifikan dengan faktor administrasi (p = 0,309). Kesimpulan: Ketidaklengkapan dokumen medis dan ketidakakuratan koding memiliki hubungan yang signifikan terhadap status klaim pending, sementara kesalahan administrasi tidak menunjukkan hubungan yang signifikan. ABSTRACT Background: The JKN claims process is a crucial element in the payment of healthcare services, but it often faces pending claims issues that can have a serious impact on hospital cash flow, including delays in medical service payments and disruption to healthcare operations. Prof. Dr. Margono Soekarjo General Hospital, as a regional referral hospital, recorded 8.05% of pending claims out of a total of 25,281 SEPs during the January–June 2024 period. This high percentage highlights the urgency of analyzing the factors causing pending claims, such as coding inaccuracies, incomplete medical documents, and administrative errors. Research Method: A quantitative study with a descriptive correlational design and a cross-sectional approach. The study population included 25,281 claim data points, with a sample size of 394 claim data points. Research Findings: Univariate analysis revealed that 87.3% of claims remained pending. The primary causes stemmed from medical factors (76.5%), followed by coding factors (21.5%), and administrative factors (2%). Diagnosis coding errors (75.7%) and inconsistencies in inpatient admission indications (63.1%) were the dominant causes within each category. Bivariate analysis using the Chi-Square test showed a significant association between pending claims and coding factors (p < 0.001) and medical factors (p < 0.001), but no significant association was found with administrative factors (p = 0.309). Conclusion: Incomplete medical documentation and coding inaccuracies have a significant association with pending claim status, while administrative errors do not show a significant association.
Item Type: | Thesis (Diploma) | ||||||||||||||||
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Uncontrolled Keywords: | Analisis Korelasional,Faktor Penyebab,Klaim Pending. ktirmik2025,rmikcrb | ||||||||||||||||
Subjects: | K Law > K Law (General) L Education > L Education (General) R Medicine > R Medicine (General) R Medicine > RZ Other systems of medicine |
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Divisions: | Jurusan RMIK > D3 Rekam Medis & Informasi Kesehatan | ||||||||||||||||
Depositing User: | CRBR Nisriinaa Nisriinaa | ||||||||||||||||
Date Deposited: | 30 Jul 2025 07:50 | ||||||||||||||||
Last Modified: | 30 Jul 2025 08:10 | ||||||||||||||||
URI: | http://repo.poltekkestasikmalaya.ac.id/id/eprint/6855 |
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