Identification of Pending Claim Factors at X Hospital City of Medan in 2021

Flora Junita Sirait, Ermi Girsang, Sri Lestari Ramadhani Nasution

Abstract


An overview of Covid 19 claims in the city of Medan submitted for the period March 2020 to November 2021 amounted to IDR 5.046 trillion, of which IDR 4.767 trillion has been verified (94.71%) and IDR 1994 trillion is pending (33,868 cases). This research aims to identify pending claim factors at one of the Covid-19 referral hospitals in Medan City in 2021. The location that will be used in this research is the Murni Teguh Memorial National Health Insurance Billing Unit. Researchers conducted interviews with informants regarding Covid-19 claims and the sample used in this research was purposive sampling, namely a sample that was considered representative of the research data by meeting the criteria, namely inclusion and exclusion. Data analysis was carried out through several stages, namely data reduction, data display and verification. The results of the research are that the factors that cause delays in hospitals are the INACBG application update, communication between patients and the doctor in charge is less open regarding clinical complaints and travel history out of town or abroad, the number of human resources is insufficient compared to patients numbering up to thousands with an HR ratio of 1: 1685 patients and DPJP 1:96 patients, this was also experienced by several other hospitals as stated in the journal entitled Review of Inpatient Claim Dispute Settlement for Corona Virus Disease 2019 (Covid-19) Patients at Ajibarang Regional Hospital in 2020 and officers had problems in implementing Covid-19 claims, namely changes in regulations up to 6 times in 3 years, so that it caused a lot of miscommunication with officers on duty within the scope of Covid-19 services, but this change in regulations was due to adapting to Covid-19 conditions.

 

Keywords:  Covid-19, Identification, Pending, Social Security Administrator

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References


Adnyana, M. S., & Budi, H. (2023). Potensi Kecurangan (Fraud) Dalam Klaim Penggantian Biaya Pelayanan Pasien Covid-19. KRISNA: Kumpulan Riset Akuntansi, 14(2), 162–174. https://doi.org/10.22225/kr.14.2.2023.162-174

Ahyar, H., Maret, U. S., Andriani, H., Sukmana, D. J., Mada, U. G., Hardani, S.Pd., M. S., Nur Hikmatul Auliya, G. C. B., Helmina Andriani, M. S., Fardani, R. A., Ustiawaty, J., Utami, E. F., Sukmana, D. J., & Istiqomah, R. R. (2020). Buku Metode Penelitian Kualitatif & Kuantitatif (Issue March).

Albertus, A. (2019). Etiologi COVID-19. Alomedika. https://www.alomedika.com/penyakit/penyakit-infeksi/coronavirus-disease-2019-covid-19/etiologi

Ambarwati, W. (2021). Pembiayaan Pasien COVID-19 dan Dampak Keuangan terhadap Rumah Sakit yang Melayani Pasien COVID-19 di Indonesia Analisis Periode Maret 2020 – Desember 2020. Jurnal Ekonomi Kesehatan Indonesia, 6(1), 23–37. https://doi.org/10.7454/eki.v6i1.4881

Dian Erika. (2021, November). Satgas Covid-19: Regulasi Sering Berubah dan Direvisi karena Dinamika Pandemi. Kompas.Com, 1. https://nasional.kompas.com/read/2021/11/03/15482001/satgas-covid-19-regulasi-sering-berubah-dan-direvisi-karena-dinamika-pandemi

Dina Lailani. (2020). RESILIENCE DALAM MENGHADAPI PANDEMI COVID-19 DI RUMAH SAKIT PUPUK KALTIM BONTANG, TAHUN 2020. In Repository Unhas. Universitas Hasanudin.

Eliyah, & Ratriana, A. (2020). Tinjauan Penyelesaian Dispute Klaim Rawat Inap Pasien Coronavirus Disease 2019 (COVID-19) di RSUD Ajibarang Tahun 2020. Jurnal Rekam Medis Dan Informasi Kesehatan, 5 No 1(1), 29–36. https://doi.org/10.31983/jrmik.v4i2.8394

Fitria Chusna, & Kristian Erdianto. (2021, September). Kebijakan Penangan Pandemi Berubah-ubah, Menko PMK : Menyesuaikan Perilaku Covid-19. Kompas.Com, 1. https://nasional.kompas.com/read/2021/09/02/08501971/kebijakan-penanganan-pandemi-berubah-ubah-menko-pmk-menyesuaikan-perilaku

Gamal Thabroni. (2022). Metode Penelitian Deskriptif: Pengertian, Langkah & Macam. Serupa.Id. https://serupa.id/metode-penelitian-deskriptif/

Herey, P., & Temesvari, N. A. (2022). Tinjauan Kelancaran Klaim Pasien Covid-19. Jurnal Rekam Medis Dan Informasi Kesehatan, 5(2), 89–95. https://doi.org/10.31983/jrmik.v5i2.8057

Hildan Hadian, & Sadeli Masria. (2022). Gambaran Karakteristik Pasien Covid-19 di Rumah Sakit X. Jurnal Riset Kedokteran, 51–56. https://doi.org/10.29313/jrk.vi.878

Kepmenkes RI. (2022). Standar Akreditasi Rumah Sakit Berdasarkan KMK 1128. Keputusan Menteri Kesehatan, 1–342.

Khaerunnisa, R., Rumana, N. A., Yulia, N., & Fannya, P. (2022). Gambaran Karakteristik Pasien Covid-19 di Rumah Sakit Mekar Sari Bekasi Tahun 2020-2021. Jurnal Manajemen Informasi Kesehatan Indonesia, 10(1), 72. https://doi.org/10.33560/jmiki.v10i1.390

Maulida, E. S., & Djunawan, A. (2022). Analisis Penyebab Pending Claim Berkas BPJS Kesehatan Pelayanan Rawat Inap Rumah Sakit Universitas Airlangga. Media Kesehatan Masyarakat Indonesia, 21(6), 374–379. https://doi.org/10.14710/mkmi.21.6.374-379

Mukrimaa, S. S., Nurdyansyah, Fahyuni, E. F., YULIA CITRA, A., Schulz, N. D., غسان, د., Taniredja, T., Faridli, E. M., & Harmianto, S. (2019). Strategi dan Teknik Penulisan Karya Tulis Ilmiah dan Publikasi. In Jurnal Penelitian Pendidikan Guru Sekolah Dasar (Vol. 6, Issue August).

Mukrimaa, S. S., Nurdyansyah, Fahyuni, E. F., YULIA CITRA, A., Schulz, N. D., غسان, د., Taniredja, T., Faridli, E. M., & Harmianto, S. (2021). Metode Penelitian Kualitatif. In Jurnal Penelitian Pendidikan Guru Sekolah Dasar (Vol. 6, Issue August).

National Health Service. (2020). NHS COVID-19. In Wikipedia. Wikipedia.

PD Sugiyono. (2019). Metode Penelitian Pendidikan.

Salwa Rizkiani Syah, S. S. (2022). ANALISIS PENGEMBALIAN BERKAS KLAIM BPJS TERHADAP KETENTUAN PENGKLAIMAN BIAYA PELAYANAN PASIEN COVID-19. Open Journal Systems, 16(1978), 7831–7842.

Santiasih, W. A. dkk. (2021). Analisis Penyebab Pending Klaim Bpjs Kesehatan Rawat Inap di RSUD Dr. RM Djoelham Binjai. Journal of Healthcare Technology and Medicine, 7(2), 1381–1394.

Shanti, H. D. (2021). BPJS Kesehatan tentang Kelengkapan Berkas Covid-19. Antara News.

Soliha, D. M., Putra, D. H., Fannya, P., & Rumana, N. A. (2022). Tinjauan Faktor Penyebab Dispute Klaim BPJS Pasien Covid-19 di RSU Kabupaten Tangerang. Jurnal Kesehatan Masyarakat, 6, 1–7.

Sucipto, C. D. (2020). Metodologi Penelitian Kesehatan. Gosyen Publishing.

Sugiyono. (2018). Metode Penelitian Manajemen. Bandung: Alfabeta.

Tarigan, I. N., Lestari, F. D., & Darmawan, E. S. (2022). Penundaan Pembayaran Klaim Jaminan Kesehatan Nasional Oleh Bpjs Kesehatan Di Indonesia: Sebuah Scoping Review. Jurnal Ekonomi Kesehatan Indonesia, 7(2), 108. https://doi.org/10.7454/eki.v7i2.6136




DOI: http://dx.doi.org/10.30829/contagion.v6i1.18376

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