Faktor Penyebab Pending Klaim BPJS di RS Militer Banjarmasin (Man & Materials)
DOI:
https://doi.org/10.32585/jmiak.v8i2.7334Abstract
RS Militer di Banjarmasin mengalami pending klaim BPJS Kesehatan rawat inap sebanyak 354 berkas pada bulan September 2024 – Maret 2025, yang berisiko mengganggu arus kas dan operasional rumah sakit. Penelitian ini bertujuan menganalisis penyebab pending klaim BPJS Kesehatan rawat inap dengan fokus pada dua faktor utama dari teori 5M, yakni Man dan Materials. Penelitian ini menerapkan metode kualitatif deskriptif dengan pengumpulan data melalui wawancara mendalam terhadap lima informan utama sebagai triangulasi yang terdiri dari koder, verifikator, kepala casemix, kepala administrasi kesehatan, dan kepala keuangan. Hasil penelitian menunjukkan bahwa faktor Man meliputi kurangnya ketelitian petugas serta hambatan komunikasi antar unit. Faktor Materials meliputi kesalahan koding seperti kombinasi diagnosis, include-exclude, lama rawat, eksisi, dan gagal data. Kesimpulan penelitian pada faktor Man ditemukan kurang telitinya petugas, keterlambatan admin ruang rawat inap dalam melengkapi dokumen, serta belum optimalnya efektivitas komunikasi antar petugas. Pada faktor Materials ditemukan kesalahan koding seperti diagnosis, include-exclude, serta lama rawat, eksisi dan kegagalan dalam tarik data.
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