Implementation of Social Security Organizing Agency (BPJS) Compliment Claim at Bahagia General Hospital Makassar

Abstract

This study aims to analyze the implementation of BPJS Health claims submission at Bahagia Makassar Public Hospital in terms of inputs, processes, and outputs. This study uses a mixed-method design with quantitative research obtained from the completeness of 419 claim files while the qualitative research uses in-depth interviews with 8 informants consisting of coders, heads of medical record installations, DPJP, nurses, laboratory personnel, radiologists, registrants and internal verifiers. Processing data using content analysis. The results show that the input indicators in submitting BPJS Health claims have not gone well. Found completeness of 419 claim files found as many as 156 (37.2%) incomplete claim files. Then HR is not sufficient in the registration section. Incentives are only given to the case-mix team and the lack of doctor's compliance in filling out the patient's medical resume and sometimes the medical record form stock runs out. SOP has not been implemented optimally. Hospital Management Information System (SIM-RS) has not been integrated with Indonesian Case-Based Groups (INA CBG’s). Then the problem in the process indicators is that records are often obtained in the medical records of inpatients that are not completely filled and file collection is not timely and there are incomplete files. So, it is advisable to give even stricter sanctions to doctors who do not complete their medical records and then to provide incentives to all those involved in implementing BPJS Health claims.