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All Journal Jurnal Rekam Medik & Manajemen Informasi Kesehatan (RAMMIK)
Rita Maulana
Politeknik Negeri Jember
Dentistry Health Professions Medicine & Pharmacology Public Health Veterinary

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Analisis Faktor Penyebab Pending Klaim BPJS Kesehatan Rawat Inap di RS Baladhika Husada Jember Rita Maulana; Gamasiano Alfiansyah; Novita Nuraini; Veronika Vestine
Jurnal Rekam Medik & Manajemen Informasi Kesehatan Vol. 3 No. 2 (2024): Oktober
Publisher : Indonesian Journal Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47134/rmik.v3i2.1911

Abstract

Claims are requests for payment of healthcare service costs by healthcare facilities to BPJS Kesehatan. Hospitals must complete the required documents according to BPJS verification procedures to avoid pending claims. The issue of pending claims still occurs at RS Tk.III Baladhika Husada Jember, with a pending rate of 11.4% from July to December 2023. This study aims to analyze the factors causing pending BPJS Kesehatan inpatient claims at RS Tk.III Baladhika Husada Jember using Robbins’ Performance Theory. This qualitative study collected data through interviews, observations, documentation, and brainstorming. The study found that pending BPJS Kesehatan inpatient claims are caused by motivation factors (lack of a reward system), opportunity factors (absence of job descriptions, insufficient staff for casemix and TPPRI), and ability factors (staff with less than 5 years of experience, lack of knowledge about BPJS inpatient claims). The study concludes that the causes of pending BPJS Kesehatan inpatient claims are motivation, ability, and opportunity factors. Proposed improvements include creating job descriptions, regularly maintaining internet networks, recruiting new staff with medical record qualifications, and providing training to enhance staff knowledge.
Co-Authors Gamasiano Alfiansyah Novita Nuraini Veronika Vestine