Background: Improvements in hospitals are needed to become a going concern hospital. One strategy that can be applied is Total Quality Management (TQM). TQM seeks continuous improvement of all hospital functions. The National Health Insurance Program (JKN) has been run by the Regional Hospital General Hospital (RSUD) Dr. H. Soewondo Kendal as of January 1st, 2014. Health financing is the most important part of implementing JKN held in hospitals by BPJS Kesehatan through submission of claims. During the implementation of JKN in Kendal General Hospital, problems were found between the difference between the visits of BPJS Health patients to hospitalizations and the Health BPJS visits claimed, thus causing pending cases of late claims. File claims that are late in submission will be included in the claim process the following month.Objective: Analyze the pending causes of the Health BPJS file based on TQM implementation.Method: This type of research uses qualitative phenomenological methods and case study research designs. The research subjects were 7 officers who were directly involved in the claim process. The research instrument is the patient claim file by paying BPJS Kesehatan. Data analysis using the Importance Performance Analysis (IPA) technique.Summary: Pending causes of claims from casemix manpower factors with educational background not medical records and lack of coding staff. The factor of the casemix section method is no Standard Operating Procedure (SOP) for claiming BPJS Health. Material factors still have claims files that cannot be submitted due to inappropriate SEP numbers or often purif. Casemix machine factors (INA CBGs) already use computers and printers. The money factor for hospital income was delayed due to pending claims and claims that failed to purify.Conclusion: The process of implementing the BPJS Health claim in Dr. Hospital H. Soewondo Kendal is in accordance with the theory but there are still file claims that are pending.Suggestion: Organize education to officers intensively and standardize the time of collecting investigations and operating reports to medical records so that the files will be claimed as soon as possible and sent to BPJS.
The unit coding in Mitra Husada Hospital in determining the diagnosis and action codes still usess manual because of the unavailability uses the ICD-10 to determine the diagnostic code and ICD-9 CM to determine the action code. In addition, there are only 2 people coding staff. The research objective is to determine the implementaion and perfomance of coding and indexing officers at Mitra Husada Hospital. The research methode uses and explanatory design or sequantial transformative strategy. The population are 100 coding cases of hospitalizatioan at Mitra Husada Hospital. The sample are 30 coding cases of hospitalization. Informative informants are 2 coding and indexing officers. Data collection of qualitative and quantitative data analysis. The results show that the coding section already has a code suitability 100%. Implementation of coding officers still need to learn MB rules and the basic causes of death in order to increase already has an SPO which has not run according to the implementaion carried out by the officer. The mixing of the coding and indexing procedures which in its implementaion was carried out separately so as to indicate the non-compliance of officers againts the SPO in the coding and indexing units.
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