Keterlambatan Pengumpulan Berkas Verifikasi Klaim BPJS di RS X: Apa Akar Masalah dan Solusinya?
DOI:
https://doi.org/10.18196/jmmr.6134Keywords:
Feedback, BPJS verification file, BPJS claim, Installation of Financial GuaranteesAbstract
This study aims to analyze root problems and the best solution of entry delays in the BPJS claim verification file to IJP (Installation of Financing Guarantee) of the hospital. This research is a qualitative descriptive research using Focus Group Discussion, Fishbone diagram and “5 Why” question methods to find the root problems. After that, the choice of alternative solutions is determined by Nominal Group Technique (NGT) and Capability Accessibility Readiness and Leverage (CARL) methods. This activity involves 2 management staffs, 3 IJP staffs, 2 pharmacists, and 7 nurses from emergency department, outpatient and inpatient units. The result of this research is written feedback by IJP for all outpatient and inpatient unit as the best solution which is expected to overcome the entry delays problem.
References
Anderson, D. L. (2013). Organizational Development: The Process of Leading Organizational Change. California: SAGE Publication, Inc.
Buchmann, P. dan Jung, U. (2008). Best-Practice Working Capital Management: Techniques for Optimizing Inventories, Receivables, and Payables. Retrieved from http://www.financepractitioner.com
Budiarto, W. dan Sugiharto, M. (2013). Biaya Klaim Ina-CBGs dan Biaya Riil Penyakit Katastropik Rawat Inap Peserta Jamkesmas di Rumah Sakit Studi di 10 Rumah Sakit Milik Kementerian Kesehatan Januari-Maret 2012. Buletin Penelitian Sistem Kesehatan. Volume 16. Surabaya: Airlangga University Press
Burke. W. W. (2013). Organization Change: Theory and Practice. California: SAGE Publication Inc.
Burke W. W. dan Noumair D. A. (2015). Organization development: A Process of Learning and Changing (third ed). New Jersey: Pearson Education Inc.
BPJS Kesehatan RI. (2016) Data Peserta BPJS. Retrieved from: https://bpjskesehatan.go.id
BPJS Kesehatan RI. (2014). . Petunjuk Teknis Verifikasi Klaim. Retrieved from: https://bpjskesehatan.go.id/bpjs/dmdocuments/Petunjuk%20Teknis%20Verifikasi%20Klaim_REV.pdf
Carter, L., Ulrich, D. dan Goldsmith, M. (2012). Best Practices in Leadership Development and Organization Change: How the Best Companies Ensure Meaningful Change and Sustainable Leadership. John Wiley & Sons, Inc.
Cheng, S.H., Chen, C.-C. & Tsai, S.L. (2012). The Impacts of DRG-Based Payments on Healthcare Provider Behaviors Under a Universal Coverage System: a Population-Based Study. Health Policy. Volume 107, 202-208.
Cummings, T. G. dan Worley, C. G. (2014). Organization Development and Change. Cengage learning.
Depkes RI. (2014). Peraturan Menteri Kesehatan Republik Indonesia Nomor 28 Tahun 2014 Tentang Pedoman Pelaksanaan Program Jaminan Kesehatan Nasional. Retrieved from: http://www.depkes.go.id/pdf.php?id=MCN-20143250002
Fassler, M., Wild, V., Clarinval, C., Tschopp, A., Faehnrich, J. A. & Biller-Andorino, N. (2015). Impact of the DRG-Based Reimbursement System on Patient Care and Professional Practice: Perspectives of Swiss Hospital Physicians. Swiss Med Wkly. Volume 145. Week 14080.
Mathauer, I. & Wittenbecher, F. (2013). Hospital Payment Systems Based on Diagnosis-Related Groups: Experiences in Low-and Middle-Income Countries. Bulletin of the World Health Organization. Volume 91,746-756A.
Mutia, M. (2016). Hubungan Antara Sistem Pembayaran Langsung dan Ina-CBGs dengan Kualitas Pelayanan Kesehatan Pasien Rawat Jalan di RSUD Dr. Moewardi. Universitas Sebelas Maret.
Or, Z. (2014). Implementation of DRG Payment in France: Issues and Recent Developments. Health Policy. Volume 117, 146-150.
Peprah, A. A. & Atarah, B. A. (2014). Assessing Patient’s Satisfaction using SERVQUAL Model: A Case of Sunyani Regional Hospital, Ghana. International Journal of Business and Social Research. Volume 4, 133-143.
Rauner, M. S. & Schaffhauser-Linzatti, M. M. (2013). Impact of Inpatient Reimbursement Systems on Hospital Performance: The Austrian Case-Based Payment Strategy. Operations Research and Health Care Policy. Springer.
RSUD Dr. Iskak Tulungagung. (2015). Profil RSUD Dr. Iskak Tulungagung Tahun 2015. Tulungagung: RSUD DR. Iskak Tulungagung
Wild, V., Pfister, E. & Biller-Andorno, N. (2012). Ethical Research on the Implementation of DRGs in Switzerland–a Challenging Project. Swiss Med Wkly. Volume 142. Week 13610.
Yavari, M., Azimi, L., Khosro Abadi, G., Baladast, M., Salaj Mahmoudi, S. & Vahidi, S. (2015). Hospital Income Loss due to Incomplete Clinical Documentation: A Survey of Service Items and Potential Causes in the Iranian Teaching Hospitals. International Journal of Hospital Research. Volume 4, 137-142.
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