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- W4386403984 abstract "Abstrak Latar Belakang: Dalam proses pengajuan klaim di RSUD Bahteramas ke BPJS Kendari ditemukan adanya pengembalian berkas klaim di bulan Januari, Februari, dan Maret tahun 2019.Tujuan: Tujuan penelitian adalah untuk mengidentifikasi Penyebab Pengembalian Berkas Klaim BPJS Rawat Inap di RSUD Bahtermas dilihat dari aspek Dispute Administrasi, Dispute Koding, dan Dispute Medis.Metode: Penelitian ini merupakan penelitian kualitatif dengan pendekatan case study.Hasil: Penyebab pengembalian berkas klaim BPJS berdasarkan Dispute Administrasi disebabkan karena adanya penyalahgunaan kartu, cara pulang pasien yang tidak sesuai, tidak adanya bukti penunjang dan terapi, serta terdapat kesalahan pada data demografi. Kedua, penyebab pengembalian berkas klaim BPJS berdasarkan Dispute Koding disebabkan karena koding yang tidak sesuai dengan diagnosis, ketidakjelasan pada penulisan dokter yang membuat diagnosis yang diajukan tidak tepat, serta tidak terisinya diagnosa akhir diresume medis. Ketiga, penyebab pengembalian berkas klaim BPJS berdasarkan Dispute Medis disebabkan karena adanya ketidaksepahaman antara verifikator dengan petugas klaim di rumah sakit mengenai diagnosis yang diajukan, banyaknya kasusnya bedah yang mengalami Permasalahan disebabkan karena tidak disertai dengan bukti penunjang. Kesimpulan: Penelitian menunjukkan bahwa adanya kasus penyalahgunaan kartu dari pasien peserta BPJS yang berobat dengan menggunakan kartu milik orang lain yang dikarenakan pemahaman sebagian pasien yang masih kurang terkait penyalahgunaan kartu, diagnosa yang tidak disertai dengan penunjang dan terapi, Kesalahan pengkodingan yang disebabkan penulisan dokter, kesalahan penginputan pemulangan pasien, kesalahan pada data demografi, dan rata-rata kasus bedah yang mengalami dispute klaim karena tidak disertai dengan penunjang. AbstractBackground: In the process of filing a claim at Bahteramas Regional Hospital to Kendari BPJS, it was found that the claim file was returned in January, February, and March 2019.Objectives: The purpose of the study was to identify the cause of returning the Inpatient BPJS Claim File at the Bahtermas Regional Hospital in terms of Administrative Dispute, Coding Dispute, and Medical Dispute.Methods: This study is a qualitative study with a case study approach.Results: The cause of returning BPJS claim files based on Administrative Dispute was due to card misuse, inappropriate way of returning patients, lack of supporting evidence and therapy, and errors in demographic data. Second, the cause of returning BPJS claim file based on Dispute Coding is caused by coding that is not in accordance with the diagnosis, unclear writing of the doctor that makes the diagnosis submitted incorrectly, as well as not filling the final diagnosis in the medical resume. Third, the cause of returning BPJS claim files based on Medical Dispute is due to a disagreement between verifiers and claimants at the hospital regarding the proposed diagnosis, the many cases of surgery that have problems caused by not being accompanied by supporting evidence.Conclusion: Research shows that there are cases of card abuse from BPJS participant patients who seek treatment using someone else's card which is due to the understanding of some patients who are still lacking related to card misuse, diagnoses that are not accompanied by support and therapy, coding errors caused by doctor writing, errors the input of patient discharge, errors in demographic data, and the average surgical case that has a dispute claim because it is not accompanied by support." @default.
- W4386403984 created "2023-09-04" @default.
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- W4386403984 date "2020-07-26" @default.
- W4386403984 modified "2023-10-05" @default.
- W4386403984 title "IDENTIFIKASI PENYEBAB PENGEMBALIAN BERKAS KLAIM BPJS RAWAT INAP DI RUMAH SAKIT UMUM DAERAH BAHTERAMAS PROVINSI SULAWESI TENGGARA TAHUN 2020" @default.
- W4386403984 doi "https://doi.org/10.37887/jakk.v1i2.38095" @default.
- W4386403984 hasPublicationYear "2020" @default.
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