Tugas Akhir DIII
Faktor-faktor Penyebab Pengembalian Berkas Klaim Rawat Inap oleh Verifikator Badan Penyelenggara Jaminan Sosial (BPJS) Kesehatan di RSUD Tugurejo
- Bagikan:
Health BPJS is organizing the social security national health insurance program (JKN). The implementation of JKN in the Hospital is using Indonesia Case Base Group (INA-CBGs). INA-CBGs system is using claim to get reimbursement the cost. The process of submit a claim have verification stages, if the verification stages does not match with the regulations then the file will be returned to the hospital. Tugurejo Hospital is a Hospital which is implementing JKN Program and Tugurejo Hospital experienced refund of claim file by verifiers of Helath BPJS. The purpose of this research is to describe the factors that cause returned inpantient claim files by the verifiers of Health BPJS in Tugurejo Hospital.
This research is using descriptive survey research method with cross sectional approach. The population is inpatient claim files that are returned by verifiers of Health BPJS and is using 97 claim files as sample. The instrument is using check list instrument.Data analysis is using univariate analysis.
The research results are obtained completeness of the claim file factor is incomplete as many as 35 files (36 %), participation administration factor isn’t appropriate as many as 24 files (25%), service administration factor isn’t appropriate as many as 8 files (8%), and health care factor isn’t appropriate as many as 41 files (42%). Completeness of the claim file factor and administrative service factor show a lack of data on the contents of the inpatient file. Administrative service shows that happen undbundling code and health services shows there are differences in coding disease and procedure between the coder hospital and verifiers of Health BPJS .
Informasi Detail
| Pernyataan Tanggungjawab |
Irmawati, Sugiharto
|
|---|---|
| Pengarang |
Marina Astrianingrum - Pengarang Tambahan
|
| NIM |
P17437113044
|
| Bahasa |
Indonesia
|
| Deskripsi Fisik |
xiv+70 page+ 28 cm
|
| Dilihat sebanyak |
1004
|
| Penerbit | Prodi DIII Rekam Medis dan Informasi Kesehatan Semarang POLTEKKES KEMENKES SEMARANG : Semarang., 2016 |
|---|---|
| Edisi |
2016
|
| Subjek | |
| Klasifikasi |
081
|