Keywords
BPJS Kesehatan
Rumah Sakit
How to Cite
Abstract
Background: The BPJS Kesehatan Claims Approval Form (FPK2) contains the claim files returned by the BPJS Kesehatan verifier to the Hospital. Due to the incomplete claim file submitted by the hospital verifier. Objective : The purpose of this study was to determine the Factor of Returning the BPJS Claim Approval Form (FPK2) for Inpatients at the Pantura M.A Sentot Patrol Hospital, Indramayu.
Method: The type of research was descriptive quantitative. The population used in this study were all inpatient BPJS patient files returned by the BPJS verifier, totaling 1,572 files at the Pantura M.A Sentot Patrol Indramayu Regional Hospital in 2020.
Results: Factors causing claims for inpatient BPJS patients at the Pantura MA Sentot Patrol Indramayu Hospital were 4 (four) causes of 7 (seven) factors including 13 (16,66%) incomplete medical resume, 28 (35,89%) inaccurate diagnosis code, 19 (24,35%) mismatching of care management, and 18 (23,07%) lack of supporting sheet attachments.
Conclusion : Tthe highest claim return factor is in the inaccuracy of diagnosis and the lowest claim return factor is in the incomplete medical resume. It is recommended to conduct a periodic evaluation of the performance of the BPJS insurance claim officer regarding the completeness of the claim requirements and the evaluation of the officer's compliance in filling out the requirements submitted to the BPJS Health.