FAKTOR-FAKTOR YANG MEMPENGARUHI KELENGKAPAN BERKAS KLAIM PASIEN JAMKESMAS DI RSUD BRIGJEND. H. HASAN BASRY KANDANGAN

• Main Authors: , MAHMUD KUSAIRI, , Dr. drg. Julita Hendrartini, M.Kes, AAK.
• Format: Theses and Dissertations NonPeerReviewed
• Published: [Yogyakarta] : Universitas Gadjah Mada 2013
• Subjects: ETD
• Online Access: https://repository.ugm.ac.id/124137/; http://etd.ugm.ac.id/index.php?mod=penelitian_detail&sub=PenelitianDetail&act=view&typ=html&buku_id=64257
• Institution: Universitas Gadjah Mada

Background: A completeness of claim filing is the important part in the claim process, the causes of incompleteness of claim files of the patient of jamkesmas (public health insurance) was caused by the incompleteness of the filling of medical record. Incomplete claim filing would impact to the hospital finance, delay in debt payment to the third parties and also impact to the quality of a service thus the level of patient satisfaction can decreased. Objectives: The study was aimed to identify the factors that influencing the completeness of claim filing of the patient of jamkesmas in Brigjend H. Hasan Basry Regional General Hospital, Kandangan. Methods: This was descriptive qualitative study on the factors that influence the completeness of claim filing of the patient of Jamkesmas. The subject of the study consist of physician, staff in claim administration, coder and coordinator of control team of Jamkesmas in Brigjend Hasan Basry Regional General Hospital, Kandangan. Results: The claim filing that was not complete of the outpatient of Jamkesmas was (81,3%), was far higher compared to the inpatient one (18.7%), about accuracy level of the coding staff in performing coding on claim files, the highest of the inaccuracy was main diagnoses establishment (23,2%). The incompleteness of the files was because there was no attachment in Referral Letter that was 33 attachments (44,0%), this was because the referral letter was did not prevailed anymore, attachment of Jamkesmas card was 27 attachments (36%) and attachment of supporting examination request was 20 attachments (26,7%). Conclusions: The causes of the claim files was not complete was the things related to the administration process, the understanding and performance of the staff to the completeness of claim files was still deficient, there was no Standard of Operational Procedures yet, evaluation of Jamkesmas program performance was did not performed yet.