Evaluation of the Role of Internal Verification Doctors in Reducing Pending Claims at Murni Teguh Medan Hospital in 2022
DOI:
10.29303/jppipa.v9iSpecialIssue.5533Published:
2023-12-25Issue:
Vol. 9 No. SpecialIssue (2023): UNRAM journals and research based on science education, science applications towards a golden Indonesia 2045Keywords:
Hospital, Pending claim, Verifying doctorResearch Articles
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Abstract
In the claim verification process, errors are still encountered which cause the claim to be pending. The problem of pending claims that occurs causes many losses for the Hospital. Therefore, an internal verifier is needed to supervise claim verification so that problems with pending claims can be minimized. Internal verification doctors have an important task in reducing the number of pending claims, especially to control the suitability of coding with diagnoses on medical resumes. The aim of this research is to analyze and describe the contribution of internal verifier doctors in reducing pending claims as well as the factors that cause pending claims and claims coding errors. The type of research used in this research is qualitative research. The research design used in this research is a descriptive research design. This research has sources as key informants, namely 4 internal verification doctors. This research also has sources as supporting informants, namely coder representatives. The conclusions of this research are: (1). Factors causing pending claims at RSU Murni Teguh Medan include: (a). Administrative factors, (b). Coding factors, (c). Medical factors. (2). The factors that cause errors in coding claims at RSU Murni Teguh Medan include: (a). HR Factors (Natural Resources) and; (b). Disagreement factor. The role of the internal verifier doctor in reducing pending claims includes: (a). Medical Document Examination; (b). In-Depth Clinical Verification; (c). Collaboration with the Filing Team; (d). Communication with BPJS.
References
Agiwahyuanto, F., Anjani, S., & Candra Stacey, S. (2021). Tinjauan Penyebab Pengembalian Berkas Klaim Bpjs Kesehatan Instalasi Rawat Jalan Kasus Fisioterapi. Care: Jurnal Ilmiah Ilmu Kesehatan, 9(3), 551–569. Retrieved from https://jurnal.unitri.ac.id/index.php/care/article/view/2205
Creswell, J. W. (2014). Reseach Design: Pendekatan, Kualitatif, Kuantitatif, dan Mixed. Yogyakarta: Pustaka Belajar.
Heltiani, N., Asroni, N., & Suryani, T. E. (2023). Analisis Ketepatan Kode Diagnosa Obstetri Terhadap Kelancaran Klaim BPJS RS.X Kota Bengkulu. Jurnal Informasi Kesehatan Indonesia (JIKI), 9(1), 1. https://doi.org/10.31290/jiki.v9i1.3634
Kurnia, E. K., & Mahdalena. (2022). Faktor Penyebab Pending Klaim BPJS Kesehatan Pasien Rawat Inap di Rumah Sakit X Periode Triwulan 1 Tahun 2022. Prosiding Seminar Informasi Kesehatan Nasional (SIKesNas), 1(1), 173–177. https://doi.org/10.47701/sikenas.vi.1741
Kusumawati, A. N. (2019). Analisis Kinerja Dokter Verifikator Internal dalam Menurunkan Angka Klaim Pending di RSUD Koja Tahun 2018. Jurnal Administrasi Rumah Sakit Indonesia, 6(1), 1–10. https://doi.org/10.7454/arsi.v6i1.3244
Nugroho P, R. H., & Pamungkas, W. J. (2022). Analisis Penyebab Keterlambatan Verifikasi Klaim BPJS pada Pembiayaan Pasien di Rumah Sakit Umum Mitra Paramedika. Jurnal Permata Indonesia, 13(1), 43–53. https://doi.org/10.59737/jpi.v13i1.54
Oktamianiza, Yulia, Y., Putri, K. A., & Rahmadhani, A. (2022). Faktor Penyebab Pending Klaim pada Pasien Rawat Inap di RSUD DR. Rasidin Padang Tahun 2022. Kesehatan Lentera, 5(2), 12–26. Retrieved from http://jurnal.politasumbar.ac.id/index.php/jl/article/view/137
Pratama, A., Fauzi, H., Nur Indira, Z., & Purnama Adi, P. (2023). Analisis Faktor Penyebab Pending Klaim Rawat Inap Akibat Koding Rekam Medis Di Rumah Sakit Umum Daerah (RSUD) Dr. Soedirman Kebumen. Jurnal Ilmiah Perekam Dan Informasi Kesehatan Imelda (JIPIKI), 8(1), 124–134. https://doi.org/10.52943/jipiki.v8i1.1225
Prima, N., Munawir, A., & Rokhman, D. (2021). Pengaruh Faktor predisposing terhadap Perilaku Ketepatan Pengisian Kode Penyakit Rawat Inap Pada Klaim JKN di era Vedika (verifikasi di kantor) Rumah Sakit Daerah Lumajang. Jurnal MID-Z (Midwifery Zigot) Jurnal Ilmiah Kebidanan, 4(1), 2013–2020. Retrieved from https://ejurnal.uij.ac.id/index.php/JM/article/view/1047
Pujihastuti, A. (2021). Penerapan Sistem Informasi Manajemen Dalam Mendukung Pengambilan Keputusan Manajemen Rumah Sakit. Jurnal Manajemen Informasi Kesehatan Indonesia, 9(2), 200. https://doi.org/10.33560/jmiki.v9i2.377
Sander, A., Indawati, L., Widjaja, L., & Rumana, N. A. (2022). Tinjauan Faktor Penyebab Pengembalian Klaim BPJS Pasien Rawat Inap di RSKD Duren Sawit Jakarta Timur Tahun 2021. SEHATRAKYAT (Jurnal Kesehatan Masyarakat) , 1(4), 387–398. https://doi.org/10.54259/sehatrakyat.v1i4.1180.
Simbolon, F., & Gani, A. (2023). Faktor-Faktor yang Mempengaruhi Terjadinya Pending Klaim Rawat Inap: Literatur Review. Jurnal Keperawatan Dan Kesehatan, 14(1), 72–78. https://doi.org/10.54630/jk2.v14i1.272
Sugiyono. (2019). Metodelogi Penelitian Kuantitatif dan Kualitatif Dan R&D. Bandung: Alfabeta.
Suharsimi, A. (2010). Prosedur Penelitian. Jakarta: Rineka Cipta.
Syafitri, D. N. (2021). Pengaruh Teknik Breastfeeding terhadap Respon Nyeri pada Bayi saat Imunisasi di Desa Koto Taluk Wilayah Kerja UPTD Kesehatan Puskesmas Teluk Kuantan. Retrieved from https://repository.ikta.ac.id/items/c1719c27-26e0-49d5-b42c-9d41c5ed1025
Wardana, Y., & Suhendro, D. (2020). Sistem Informasi Pemesanan dan Pembayaran Kamar pada Apple Hotel Perdagangan Kabupaten Simalungun. Jurnal Ilmiah Media Sisfo, 14(1), 54–63. https://doi.org/10.33998/mediasisfo.2020.14.1.781
Widjaja, L. (2015). Modul 1 Konsep Dasar Rekam Medis Dan Informasi Kesehatan. Universitas Esa Unggul.
Widyaningrum, B. N., Riska, B., & Rivana, A. (2021). Pengaruh Kelengkapan Dokumen Klaim INA-CBG’S di RS Pantiwilasa. JURMIK (Jurnal Rekam Medis Dan Manajemen Informasi Kesehatan), 1(2), 31–37. Retrieved from https://unkartur.ac.id/journal/index.php/jurmik/article/view/40
Yulianti, E., & Fitriyah, N. (2022). Persepsi User Terhadap Sistem Klaim Bpjs Kesehatan Dalam Kerangka Technology Acceptance Model (TAM) Pada Rumah Sakit. JIMAT (Jurnal Ilmiah …, 13, 948–959. Retrieved from https://ejournal.undiksha.ac.id/index.php/S1ak/article/view/46490%0Ahttps://ejournal.undiksha.ac.id/index.php/S1ak/article/download/46490/23222
Author Biographies
Sri Lestari Ramadhani Nasution, Universitas Prima Indonesia
Yohana Candra Andini Hutabarat, Universitas Prima Indonesia
Chrismis Novalinda Ginting, Universitas Prima Indonesia
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