Analisis Angka Kejadian Pending Klaim JKN Pasien Rawat Inap di RSUD dr. Soeratno Gemolong
DOI:
https://doi.org/10.32585/jmiak.v7i2.5969Abstract
Berdasarkan survei pendahuluan di RSUD dr. Soeratno Gemolong dari berkas klaim rawat inap yang diajukan terdapat 33 berkas dikembalikan pada bulan Oktober Triwulan IV tahun 2023. Tujuan penelitian ini untuk mengidentifikasi faktor penyebab pengembalian berkas klaim JKN. Jenis penelitian ini merupakan penelitian deskriptif kualitatif dengan pendekatan triangulasi. Subjek penelitian ini adalah petugas casemix dan petugas coding di RSUD dr. Soeratno Gemolong. Objek dalam penelitian ini adalah berkas pengembalian klaim JKN pasien rawat inap bulan oktober dan desember triwulan IV tahun 2023 yang berjumlah 167 berkas pengembalian. Instrumen penelitian ini menggunakan pedoman observasi dan pedoman wawancara. Cara pengumpulan data dengan observasi dan wawancara tidak terstruktur. Analisis data yang digunakan adalah deskriptif. Hasil penelitian menunjukkan bahwa belum ada SOP untuk pengajuan klaim. Terdapat beberapa syarat yang harus dipenuhi dalam pengajuan klaim JKN pasien rawat inap. Pengembalian pada bulan November 3,18% dan Desember 5,38%. Pengembalian berkas klaim tertinggi pada bulan Desember. Penyebab pengembalian berkas klaim karena ketidaktepatan kode diagnosis, ketidaklengkapan informasi penunjang dan ketidaklengkapan berkas cara keluar pasien. Hal itu dapat menyebabkan tertundanya penggantian dana dari BPJS untuk rumah sakit. Berdasarkan penelitian sebaiknya pihak rumah sakit membuat SOP tentang pengajuan klaim sehingga dapat mengurangi kasus pengembalian klaim.
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