Perpustakaan Terpadu

Klaim pending merupakan klaim yang dikembalikan BPJS Kesehatan kepada rumah sakit, didalam klaim pending terdapat berbagai penyebab seperti faktor medis, koding, dan administrasi. Dampak yang akan diterima yaitu tertundanya pembayaran klaim yang mengakibatkan rumah sakit mengalami cash flow. Tujuan dari penelitian yaitu untuk mengetahui faktor medis, koding, administrasi penyebab klaim pending rawat inap (RI) BPJS Kesehatan di RSUD Kanjuruhan Kabupaten Malang. Metode yang digunakan yaitu penelitian deskriptif. Populasi penelitian terdiri dari 873 dokumen klaim pending RI periode April- September 2022 dan diambil sampel penelitian secara random sampling sebanyak 90 dokumen klaim. Pengumpulan data dilakukan dengan cara telaah dokumen. Didapatkan penyebab klaim pending RI dari faktor koding sebesar 35 (39%) dokumen, faktor administrasi sebesar 33 (37%) dokumen dan faktor medis sebesar 22 (24%) dokumen

Pending claims are claims that are returned by BPJS Health to hospitals, in pending claims there are various causes such as medical factors, coding, and administration. The impact that will be received is the delay in payment of claims which results in the hospital experiencing cash flow. The purpose of this research is to find out the medical, coding, administrative factors that cause pending claims for hospitalization (RI) BPJS Kesehatan at Kanjuruhan Hospital, Malang Regency. The method used is descriptive research. The research population consisted of 873 RI pending claim documents for the April-September 2022 period and the research sample was taken by random sampling of 90 claim documents. Data collection is done by means of document review. The causes of RI pending claims were obtained from coding factors of 35 (39%) documents, administrative factors of 33 (37%) documents and medical factors of 22 (24%) documents