EVALUATION ONTHE IMPLEMENTATION OF OUTPATIENTS BPJS CLAIMS IN PKU MUHAMMADIYAH HOSPITAL UNIT GAMPING YOGYAKARTA
Retno Ambar Rukmi, Mahendro Prasetyo Kusumo
Masters in Hospital Management, Postgraduate, Muhammadiyah University of Yogyakarta
Abstract
BACKGROUND: The National Social Security System (Sistem Jaminan Sosial Nation) is a type of social protection aiming to support all citizens, in terms of health particularly, in order to fulfill the basic needs for a decent life. The health care provider care paid in capitation by BPJS (Badan Penyelenggara Jaminan Sosial) or (Social Insurance Administration Organization). The payment system for Advanced Health Service Providers (Hospitals) is made through the INA CBG (Indonesia Case Base Groups) is tarif by BPJS. However, problems often arise in regards to BPJS claims. The data collection is performed in several stages, starting with the formulation of the type of research and research designs, and also involvement of subjects and objects of research as the participants of the study. The next stage is to create the instruments and analyze the data in order to investigate the problems related to BPJS claims in PKU Muhammadiyah Yogyakarta Gamping METHOD: this research is type of qualitative research with case study. The subjects of this study are internal hospital. RESULT AND DISCUSSION: The study involved 8 (eight) informants in total. The procedure for claiming BPJS include administrative verification, participant verification (eligibility) and purification. BPJS administrative verification conducted by PKU Muhammadiyah Gamping Hospital towards both participants and providers has been going well. Conformity between diagnosis and billing procedure with ICD 10 and ICD 9 codes in INA CBG is at PKU Muhammadiyah Gamping Hospital has complied with the procedures of BPJS health service verification. However, verification in terms of data purification using INA CGB is software is not thoroughly implemented due to the fact that only a few people are familiar with this verification. CONCLUSION : there are problems with BPJS outpatient claims at PKU Muhammadiyah Gamping Hospital including the difference in diagnosis between the hospital and the verifier. It does not examine the registration part in selecting patients who will enter in hospital. Incomplete files filled by doctors Some cases of clerics that are not paid by the BPJS.
Keywords: BPJS, Verification
Topic: International Symposium of Engineering, Technology, and Health Sciences