ANALISIS RISIKO DISPUTE KLAIM COVID TERHADAP OPERASIONAL CASHFLOW DI RS KARTIKA HUSADA JATIASIH

Pramesti, Ariditya (2022) ANALISIS RISIKO DISPUTE KLAIM COVID TERHADAP OPERASIONAL CASHFLOW DI RS KARTIKA HUSADA JATIASIH. S2 thesis, Universitas Kristen Indonesia.

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Abstract

Klaim yang dinyatakan dispute pada klaim Covid yang diajukan oleh rumah sakit menyebabkan gangguan pada operasional cashflow RS Kartika Husada Jatiasih. Berdasarkan data rumah sakit pada bulan Maret - Desember 2021, klaim Covid yang dinyatakan dispute di beberapa bulan pengajuan ada yang mencapai sampai diatas 50%. Penelitian ini dilakukan untuk mengidentifikasikan penyebab dispute klaim tersebut dan risiko dari tiap penyebab klaim dispute serta menentukan mitigasi atas risiko penyebab klaim dispute. Pengumpulan data dilakukan dengan cara survei angket dan wawancara. Sumber informasi, melakukan pendataan pada 20 tenaga rumah sakit yaitu pada unit Casemix , unit Keuangan, unit Farmasi, unit Laboratorium, dan juga dokter spesialis. Hasil penelitian menunjukan bahwa dalam analisis penyebab dispute klaim yaitu Man, Environment, Method, Material dan Communication. Dalam analisis tersebut terdapat 24 risiko dari penyebab klaim dispute. Ditemukan 7 risiko masuk dalam kategori Issue, 12 risiko masuk dalam Supplementary Issue dan 5 risiko masuk dalam kategori Acceptable. 7 risiko tertinggi yang masuk dalam kategori Issue yaitu: “Seluruh stake holder rumah sakit tidak memahami akibat dispute klaim”, “Pelayanan yang diberikan petugas tidak optimal karena kebutuhan operasional tidak dapat terpenuhi”, “Seluruh stake holder rumah sakit tidak memahami cara dan ketentuan pengisian form PE”, “ Tidak lengkapnya pengisian form PE pasien sangat mengganggu proses administrasi klaim”,”Medical Record manual sering menghambat proses pengklaiman”,”Tidak bridgingnya SIMRS dan INACBGS mempengaruhi proses pengklaiman” dan “Dinkes Provinsi dan Dinas Kesehatan Kota Bekasi serta BPJS tidak berkoordinasi dengan baik”. Risiko yang masuk dalam kategori Issue dan Supplementary Issue harus segera ditangani sebagai usaha memperkecil risiko yang terjadi di rumah sakit. Kata Kunci: Dispute Klaim, Risiko, RS Kartika Husada Jatiasih / Disputed claims in COVID-19 claims submitted by hospitals have disrupted the cash flow operations of Kartika Husada Jatiasih Hospital. Based on hospital data from March to December 2021, disputed COVID-19 claims in some months reached over 50%. This study was conducted to identify the causes of these disputed claims and the risks associated with each cause, as well as to determine mitigation measures for these risks. Data collection was conducted using a questionnaire survey and interviews. Data were collected from 20 hospital personnel, including those in the Casemix unit, Finance unit, Pharmacy unit, Laboratory unit, and specialist doctors. The study results showed that the causes of claim disputes were identified as Human, Environment, Method, Material, and Communication. The analysis identified 24 risks associated with the causes of claim disputes. Seven risks were categorized as Issues, 12 as Supplementary Issues, and five as Acceptable. The 7 highest risks included in the Issue category are: "All hospital stakeholders do not understand the consequences of claim disputes," "Services provided by staff are not optimal because operational needs cannot be met," "All hospital stakeholders do not understand the method and requirements for completing the PE form," "Incomplete completion of the patient's PE form significantly disrupts the claims administration process," "Manual medical records often hinder the claims process," "Lack of bridging SIMRS and INACBGS affects the claims process," and "The Provincial Health Office, Bekasi City Health Office, and BPJS do not coordinate well." Risks included in the Issue and Supplementary Issue categories must be addressed immediately to minimize the risks occurring at the hospital. Keywords: Claim Dispute, Risk, Kartika Husada Hospital Jatiasih

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