Determinants of Approval Claims at Hospital Among COVID-19 Patients
DOI:
https://doi.org/10.30597/mkmi.v18i2.19536Keywords:
Claim, COVID-19, reimbursementAbstract
The COVID-19 pandemic is an issue that is being faced by Indonesia and even most countries in the world. The impact due to the COVID-19 pandemic is disruption of hospital with cash flow. It was caused by the delay in hospital payment of claims which are not approved by Badan Penyelenggara Jaminan Sosial (BPJS Kesehatan). Siloam Sentosa Hospital Bekasi provides services for COVID-19 patients. However, out 81 claims of COVID-19 patients in August-October 2020, there were 65 claims (80.25%) not approved by BPJS Kesehatan. The purpose of this study was to analyze the factors that affect the approval claims among patients with COVID-19 at Siloam Sentosa Hospital Bekasi. This type of research was descriptive analysis with a quantitative approach. The research population was 108 claims and the sample used the total population. A Logistic regression test was used to analyze the data. The results of the study explained the completeness of claims, the quality of the medical resume, the completeness of filling out the epidemiological investigation form, and the quality of clinical coding that affected the approval claims. The study showed 21.5% of other factors that are not examined can affect the approval claims. Socialization of policies related to payment of claims to hospitals as well as monitor and evaluate from both hospitals and BPJS Kesehatan need to be improved to prevent claims that are not approved.
References
Ohannessian R, Duong TA, Odone A. Global Telemedicine Implementation and Integration Within Health Systems to Fight the COVID-19 Pandemic: A Call to Action. JMIR Public Health and Surveillance. 2020; 6(2):18810.
Aditia A. COVID-19: Epidemiologi, Virologi, Penularan, Gejala Klinis, Diagnosa, Tatalaksana, Faktor Risiko dan Pencegahan Arianda. Jurnal Penelitian Perawat Profe-sional. 2021;3(11):653–660.
Satuan Tugas Penanganan COVID-19. Peta Sebaran COVID-19. [Report]. 2022. Availa-ble from: https://covid19.go.id/peta-sebaran.
Ambarwati W. Pembiayaan Pasien COVID-19 dan Dampak Keuangan terhadap Rumah Sakit yang Melayani Pasien COVID-19 di Indonesia Analisis Periode Maret 2020 – Desember 2020. Jurnal Ekonomi Kesehatan Indonesia. 2021;6(1):23–37.
Kemenkes RI. Keputusan Menteri Kesehatan RI No. HK.01.07/Menkes/4344/2021 Tentang Petunjuk Teknis Klaim Penggantian Biaya Pelayanan Pasien Corona Virus Disease 2019 (Covid-19) Bagi Rumah Sakit Penyelenggara Pelayanan Corona Virus Disease 2019 (Covid-19). Jakarta: Kementerian Kesehatan Republik Indonesia; 2021.
Kemenkes RI. Keputusan Menteri Kesehatan RI No. HK.01.07-MENKES-4344-2021 Tentang Juknis Penggantian Biaya Pasien COVID-19 Bagi RS Penyelenggara Pelayanan COVID-19. Jakarta: Kementerian Kesehatan Republik Indonesia; 2021.
BPJS Kesehatan. Kontribusi Penanganan Covid 19. Info BPJS Kesehatan. 2020;83:1–24.
Muroli CJ, Rahardjo TBW, Kodyat AG. Faktor-Faktor yang Mempengaruhi Terjadinya Pending Klaim Rawat Inap Oleh BPJS di RSAB Harapan Kita Jakarta Barat Tahun 2019. 2020. Jurnal Manajemen dan Administrasi Rumah Sakit Indonesia. 2020;4(2):191–197.
Ariyanti F, Gifari MT. Analisis Persetujuan Klaim BPJS Kesehatan pada Pasien Rawat Inap. Jurnal Ilmu Kesehatan Masyarakat. 2019;8(4):156–166.
EP. AA. Faktor-Faktor Penyebab Klaim Tertunda BPJS Kesehatan RSUD Dr. Kanujoso Djatiwibowo Periode Januari-Maret 2016. Jurnal Administrasi Rumah Sakit. 2018;4(2):122–134.
Supriadi, Rosania S. Tinjauan Berkas Klaim Tertunda Pasien JKN Rumah Sakit Hermina Ciputat 2018. Jurnal Vokasi Indonesia. 2019;7(2):19–26.
Astuti R. Faktor-Faktor yang Mempengaruhi Kelancaran Klaim BPJS Rawat Inap di Rumah Sakit Atma Jaya. [Thesis]. Jakarta: Fakultas Ilmu-Ilmu Kesehatan Program D4 Manajemen Informasi Kesehatan Unversitas Esa Unggul; 2019. Available from: https://digilib.esaunggul.ac.id/faktorfaktor-yang-mempengaruhi-kelancaranklaim-bpjs-rawat-inap-di-rumah-sakit-atma-jaya-12324.html.
Eliyah, Ratriana AU. Review of Resolving Dispute Claim on Inpatients of Coronavirus Disease 2019 (COVID-19) in RSUD Ajibarang in2020. Jurnal Rekam Medis dan In-formasi Kesehatan. 2022;5(1):29–36.
Nugraheni WP, Hartono RK, Situmorang C, Thabrany DH. Pengalaman Indonesia dalam Penanganan Dispute Klaim Covid-19 Indonesia Experience in Handling Covid-19 Dispute Claim. Aspirasi: Jurnal Masalah-Masalah Sosial. 2022;13(1):59–70.
Putri AFBSC. Hubungan Kelengkapan Persyaratan Klaim Terhadap Persetujuan Klaim Oleh Verifikator BPJS Di RSUP Dr. Soeradji Tirtonegoro. Prosiding Seminar Rekam Medis dan Manajemen Informasi PORMIKI Jawa Tengah; 2020;1–10.
Santiasih WA, Simanjorang A, Satria B. Analisis Penyebab Pending Klaim BPJS Kesehatan. Journal of Healthcare Technology and Medicine. 2021;7(2):1381–1394.
Irmawati I, Kristijono A, Susanto E, Belia Y. Penyebab Pengembalian Berkas Klaim Badan Penyelenggara Jaminan Sosial (BPJS) Pasien Rawat Inap Ditinjau dari Syarat-Syarat Pengajuan Klaim di RSUD R.A Kartini Jepara. Jurnal Rekam Medis dan Informasi Kesehatan. 2018;1(1):45-51.
Temesvari NA, Nurmalasari M, Qomarania WZ. Peningkatan Pengetahuan Kualitas Pelayanan Rekam Medis. Jurnal Abdimas. 2021;7(4):328–332.
Utomo Y, Markam H. Pengaruh Kompetensi PMIK terhadap Kualitas Koding Klinis di RSU Vertikal Kementerian Kesehatan DKI Jakarta. Jurnal Manajemen Informasi Kesehatan Indonesia. 2020;8(2):102–106.
Agiwahyuanto F, Hartini I, Sudiro. Efforts to Prevent Differences Between Clinical and Insurance Diagnosis After Implementing the National Health Insurance Program in Services of Healthcare and Social Security Agency (Health BPJS) Study at Semarang City Public Hospital. Jurnal Manajemen Kesehatan Indonesia. 2016;4(2):84–90.
Ernawati D, Mahawati E. Peran Tenaga Medis dan Koder dalam Mewujudkan Kelengkapan Data dan Akurasi Klaim INA-CBG’s (Studi Kasus Sectio Cesaria Pasien Jamkesmas di RSU Kota Semarang). Forum Informatika Kesehatan Indonesia 2015. 2015:65–71.
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