GAMBARAN SISTEM PENGAJUAN KLAIM PASIEN RAWAT INAP BPJS KESEHATAN DI RSUD X KABUPATEN BANDUNG

DESCRIPTION OF THE CLAIM SUBMITTING SYSTEM OF BPJS INPATIENT AT HOSPITAL X IN BANDUNG REGENCY

Authors

  • Wiwin Winarti Politeknik Al Islam Bandung
  • Tania Defi Sukmawati Politeknik Al Islam Bandung

DOI:

https://doi.org/10.38215/jtkes.v4i2.78

Keywords:

BPJS kesehatan, claim document, claim submission, inpatient, hospital

Abstract

The BPJS Health program has been launched for more than six years, but the process of making claims from the hospital to the BPJS Health Office continues to be developed. In line with the policy changes issued by the BPJS Health regulations, hospitals must also follow these changes, for the smooth payment of claims so that the cash flow of hospital operations is not disrupted. This paper aims to find out the system for submitting claims for BPJS Health inpatients at RSUD X, Bandung Regency. The location of data collection is in the BPJS Health Inpatient Claim Unit, RSUD X Bandung Regency, on June 14-24 2021. The type of paper uses descriptive qualitative research, using data collection techniques of observation, interviews, and documentation. Observations were made at the BPJS Health Inpatient Claim Unit at RSUD X Bandung Regency, then interviews were conducted with two BPJS Health inpatient claims officers, as well as documentation of the claim requirements file. The collected data is then analyzed to draw conclusions. The result of writing is that the claim file and the submission of BPJS Health inpatient claims at RSUD X Bandung Regency are in accordance with the references used, namely Presidential Regulation Number 82 of 2018 and BPJS Health Regulation Number 7 of 2018. However, the SOPs and flowcharts for these activities have not been documented. For this reason, in this paper, it is recommended that the SOP and flowchart of the BPJS Health inpatient claim submission activities is documented. In addition, no less important is the documentation of the Director's Decree for setting regulations as a reference in the activity of submitting BPJS Health inpatient claims at RSUD X, Bandung Regency, so that officers have standards/guidelines as internal references in carrying out their duties.

References

[Rujukan dari Buku]
Peraturan Badan Penyelenggara Jaminan Sosial Kesehatan Nomor 7 Tahun (2018). Tentang Pengelolaan Administrasi Klaim Fasilitas Kesehatan Dalam Penyelenggaraan Jaminan Kesehatan. Jakarta.
Peraturan Presiden Republik Indonesia Nomor 82 Tahun (2018). Tentang Jaminan Kesehatan. Jakarta.
Undang-Undang Republik Indonesia Nomor 36 Tahun (2009). Tentang Kesehatan. Jakarta.
Undang-Undang Republik Indonesia Nomor 44 Tahun (2009). Tentang Rumah Sakit. Jakarta.

[Rujukan dari Internet]
Nurulliah, Novianti. 2020. Rumah Sakit Terancam Bangkrut, Ridwan Kamil : Tagihan BPJS Numpuk, Pembayaran Klaim Bakal Dipercepat [Online]. Tersedia : https://www.pikiran-rakyat.com/jawa-barat/pr-01793544/rumah-sakit-terancam-bangkrut-ridwan-kamil-tagihan-bpjs-numpuk-pembayaran-klaim-bakal-dipercepat [30 Juni 2021].
Opitasari, Cicih., & Nurhayati. (2019). Evaluation of Claim Submission and Returning for BPJS Inpatient Service : A Case Study of Hospital X in 2017. [Online]. Tersedia:https://ejournal2.litbang.kemkes.go.id/index.php/hsji/article/view/1845/1090 [6 Agustus 2021].

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Published

2022-01-28

How to Cite

Winarti, W., & Sukmawati, T. D. (2022). GAMBARAN SISTEM PENGAJUAN KLAIM PASIEN RAWAT INAP BPJS KESEHATAN DI RSUD X KABUPATEN BANDUNG: DESCRIPTION OF THE CLAIM SUBMITTING SYSTEM OF BPJS INPATIENT AT HOSPITAL X IN BANDUNG REGENCY. Jurnal Teras Kesehatan, 4(2), 63–72. https://doi.org/10.38215/jtkes.v4i2.78