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ANALISIS PENGAJUAN KLAIM RAWAT INAP COVID-19 DI RSUD SLEMAN

RADINDA AULIA W, Nuryati, S.Far., M.P.H

2022 | Tugas Akhir | D4 MANAJEMEN INFORMASI KESEHATAN

Latar Belakang : Keterlambatan pengajuan klaim rawat inap COVID-19 di RSUD Sleman disebabkan oleh juknis yang berubah ubah, kurangnya SDM, serta ketidaklengkapan berkas klaim. Kendala dalam pengajuan klaim tersebut mengakibatkan proses persetujuan antara pihak rumah sakit dengan pihak BPJS dan Kemenkes menjadi tertunda sehingga pihak rumah sakit tidak segera mendapat penggantian biaya pelayanan pasien rawat inap COVID-19. Tujuan : Menganalisis alur pengajuan, faktor penyebab keterlambatan pengajuan , risiko penyebab terjadinya keterlambatan pengajuan klaim rawat inap COVID-19 di RSUD Sleman Metode : Jenis penelitian yang digunakan adalah penelitian deskriptif dengan pendekatan kualitatif dan rancangan penelitian studi kasus. Teknik pengumpulan data menggunakan teknik wawancara, observasi, dan studi dokumentasi. Hasil: Alur pengajuan klaim rawat inap COVID-19 di RSUD Sleman sudah sesuai dengan Kepmenkes No. HK. 01. 07 /MENKES/5673/2021, namun belum memiliki pedoman khusus. Terdapat delapan penyebab keterlambatan pengajuan yaitu faktor man (kurangnya jumlah petugas klaim, kurangnya jumlah petugas scan, kurangnya komunikasi antar bagian, dan petugas kurang teliti dalam menginputkan tindakan dan pemeriksaan penunjang) , methods ( belum terdapat SPO), material ( berkas klaim COVID-19 yang kembali dari bangsal perawatan kurang lengkap dan tidak ada penanda khusus untuk berkas rekam medis COVID-19), machine (jaringan internet di RSUD Sleman kurang stabil). Kesimpulan : Unit kerja yang berkaitan dengan proses klaim COVID-19 sebaiknya segera melakukan evaluasi pada prioritas tertinggi penyebab keterlambatan klaim diantaranya adalah segera mengimplementasikan rancangan checklist kelengkapan berkas klaim COVID-19, dan melakukan manajemen atau pengaturan SDM. Kata Kunci : Klaim COVID-19, Faktor Penyebab, Fishbone, Pareto

Background : The delay of claim submission for COVID-19 hospitalization in Sleman Regional Hospital is caused by the changing technical guidelines, lack of human resources, and incomplete claim files. The obstacle in this claim submission resulted in the approval process between the hospital and BPJS and Ministry of Health being delayed so that the hospital does not immediately get reimbursement for the service cost of COVID-19 inpatients. Objectives : To analyze the submission flow, the factors causing the delay in submission, the risk of the causes in claim submission delay for COVID-19 hospitalization at Sleman Regional Hospital. Methods : The type of research was descriptive research with a qualitative approach and case study research design. The data collection techniques were interview, observation, and documentation study. Results : The flow of claim submission for COVID-19 hospitalization at RSUD Sleman is in accordance with Kepmenkes No. HK. 01.07 /MENKES/5673/2021, but has not had specific guidelines yet. There are eight causes of the late submission, namely the factor of man (lack of claim officers&scan officers, lack of communication among sections, and officers who are not careful in inputting actions and supporting examinations), methods (there is no SPO), material (the COVID-19 claim files returned from the treatment ward are incomplete and there is no special marker for the COVID-19 medical record files), machine (the internet network at Sleman Regional Hospital is less stable). Conclusion : The work units related to the COVID-19 claim process should immediately evaluate the highest priority of the causes in claim delay, including immediately implementing a checklist design for the completeness of COVID-19 claim files, and carry out management or arrangement of human resources. Keywords : Claims of COVID-19, Causative Factors, Fishbone, Pareto

Kata Kunci : Klaim COVID-19, Faktor Penyebab, Fishbone, Pareto / Claims of COVID-19, Causative Factors, Fishbone, Pareto

  1. D4-2022-450956-abstract.pdf  
  2. D4-2022-450956-bibliography.pdf  
  3. D4-2022-450956-tableofcontent.pdf  
  4. D4-2022-450956-title.pdf