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All Journal Jurnal Ekonomi Kesehatan Indonesia
Tarigan, Immanuel Natanael
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Decision Sciences, Operations Research & Management Economics, Econometrics & Finance Health Professions Medicine & Pharmacology Public Health

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PENUNDAAN PEMBAYARAN KLAIM JAMINAN KESEHATAN NASIONAL OLEH BPJS KESEHATAN DI INDONESIA: SEBUAH SCOPING REVIEW Tarigan, Immanuel Natanael; Lestari, Feni Dwi
Jurnal Ekonomi Kesehatan Indonesia Vol. 7, No. 2
Publisher : UI Scholars Hub

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Abstract

Since it was first implemented, the utilization of the National Health Insurance (JKN) has been increasing each year. Currently, almost all hospitals accept JKN patients. However, the JKN claim payment process did not run as conveniently as expected, and there were frequent delays in payment. This delay becomes a major obstacle in hospitals, especially public hospital, which relies heavily upon JKN patients for its cashflow. This study aims to determine the magnitude of the delay in the payment of JKN claims and what factors are involved, especially in public hospitals. This study was conducted using the scoping method review with Arksey and O'Malley guidelines. The study was conducted by including publications from 2014 to 2022. A literature search was carried out on 3 electronic databases and additional searches, found a total of 530 articles. A total of 35 studies were analyzed in this study. This study found that the delay in the payment of JKN patient claims was around 2.5-47.7% per month. Several factors that were found to be closely related to the delay in payment of this claim were administrative completeness, the number of staff involved, the ability and accuracy of the coder, the completeness of the medical resume by the doctor in charge of the patient, good communication between the doctor in charge of the patient and coder, the use of internal verifiers, facility support. and infrastructure as well as the existence of standard operating procedures.
Faktor yang Memengaruhi Kinerja Verifikasi Dokter Verifikator Internal Medis dalam Proses Klaim Pasien Jaminan Kesehatan Nasional di Rumah Sakit Cipto Mangunkusumo Tarigan, Immanuel Natanael; Oktamianti, Puput; Darmawan, Ede Surya
Jurnal Ekonomi Kesehatan Indonesia Vol. 9, No. 2
Publisher : UI Scholars Hub

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Since the implementation of the National Health Insurance, hospitals must be able to manage JKN claims properly. One way to properly manage the situation is by employing a medical internal verification doctor. This study aims to determine the factors that influence the performance of medical internal verification doctor based on the percentage of claim eligibility that has been verified. The research was conducted using a case study method with a qualitative and quantitative approach. The study was conducted on 16 medical internal verification doctors using questionnaires and in-depth interviews. The results of the study found that the performance of medical internal verification doctors in January-June 2022 was 81.45%, lower than other hospital owned by the ministry of health (85-94%). This study also found that the factors related to the verification performance of medical internal verification doctors were demographic in the form of years of service as medical internal verification doctors and other workloads, knowledge, job satisfaction in general, satisfaction with salary, benefits and rewards for work, satisfaction with the nature of work, as well as satisfaction with the operational situation of work and colleagues. Other factors in medical internal verification doctors verification performance is organizational support, such as standard operating procedures, training and education opportunities and opportunities for communication with external parties. Other factors related to the verification performance of VIM doctors are the passion as a medical internal verification doctor, tasks assignment, feedback on performance and criteria or standards for becoming a medical internal verification doctors.
Co-Authors Ede Surya Darmawan Lestari, Feni Dwi Puput Oktamianti