BPJS住院对肺炎Covid-19病例诊断的未决索赔因素

I. Mathar, ✉. Crismantoro, Budi Saputro, Wahyu Wijaya Widiyanto
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引用次数: 0

摘要

未决索赔是一个可能影响医院的问题,也就是说,更多的是关于医生和雇员服务的延误。有几个因素可能导致未决索赔,但未决案件的主要原因在于填写医疗简历表时文件的完整性和未记录的实验室结果。本研究是描述性定性的,有10个验证员工和116个文件样本。它使用与验证人员的面谈和对未决文件的观察,以及对5M管理要素(人、钱、方法、机器、材料)的识别来确定导致未决的因素。研究结果于2021年取得成果;在住院申请中,待处理的肺炎COVID-19诊断请求文件多达1167个,过期文件多达94个,通过验证的文件多达145个,肺炎COVID-19诊断文件多达1420个。如果计算一下,未决案件的比例为82.18%,通过审核的比例为11.21%,过期的比例为6.61%。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Factors Causing Pending Claims of BPJS Hospitalization on the Diagnosis of Pneumoni Covid-19 Cases
Pending claims are an issue that can impact hospitals, that is, more about delays in the service of doctors and employees. Several factors can cause pending claims, but the main cause of pending cases lies in the completeness of the file on the filling out of the medical resume sheet and the laboratory results that are not recorded. This research is descriptive qualitative with a population of 10 verification employees and a sample of 116 files. It uses interviews with verification officers and observations on pending files—and the identification of 5M management elements (Man, Money, Method, Machine, Materials) to determine what factors cause pending to come from. The results of the study obtained results In 2021; there were pending claims on the diagnosis of pneumoni covid-19 cases in as many as 1167 files, files that had expired were as many as 94 files and files that passed verification were as many as 145 of the total submissions of hospitalization and files for the diagnosis of pneumoni covid-19 cases were as many as 1420 files. If calculated, the percentage for pending cases is 82.18%, passed verification is 11.21% and files that expired as much as 6.61%.
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