Cases of Dispute and Pending Claims in Hospitals in the Era of National Health Insurance

2022 ◽  
Vol 2 (1) ◽  
pp. 32-38
Author(s):  
Mrs. Yastori
Keyword(s):  
Health Insurance ◽  
Health Services ◽  
National Health Insurance ◽  
National Health ◽  
National Health Insurance System ◽  
Quality Health ◽  
Icd 10 ◽  
Data Collection Technique ◽  
Observation Method

Background: Indonesia began to implement a National Health Insurance System based on the National Social Security System in 2014 with the support of government regulations which states that Indonesia requires every citizen to have access to comprehensive and quality health services so that can continue their life through the National Health Insurance. Pending and dispute claims are problems that often occur in the era of national health insurance that can affect hospital budget allocation and planning policies, increasing the high cost burden for hospitals which will affect the quality of health services provided. The purpose of this study was to determine pending cases and dispute claims in hospitals in the Era of National Health Insurance.Methods: The study used a descriptive method with a qualitative approach. The data collection technique used is the observation method, namely directly to the e-claim file at several hospitals. 15 e-claim files taken in total from April – July 2021.Results: Obtained 13 cases of pending claims and 2 cases of dispute claims. Cases pending claims are caused by not complying with the code with evidence or resources, not in accordance with medical clinical practice guidelines and the rules of the health insurance provider.Conclusions: In coding, it is necessary to match the theory on the ICD-10, update the ICD-10. It is necessary to understand the rules and provisions made by the insurer and the related guidelines and rules. Please be aware of every latest code update.

Effectivity of National Health Insurance on Maternal Health in Developing Countries: A Systematic Review

2020 ◽  
Author(s):  
Eva Nur Octavia ◽  
◽  
Pandu Riono ◽  
Keyword(s):  
Developing Countries ◽  
Health Insurance ◽  
Maternal Health ◽  
Health Services ◽  
National Health Insurance ◽  
National Health ◽  
Maternal Health Services ◽  
Health Insurance System ◽  
National Health Insurance System ◽  
Insurance System

ABSTRACT Background: Improving maternal health services is one of the main objectives in reducing maternal mortality. The national health insurance system is one of the efforts to achieve Universal Health Coverage (UHC) which aims to ensure that people can access health services without financial difficulties as stated in the third point of SDGs 2030. This system ensures that women are able to access quality maternal health services. This study aimed to review the effectiveness of national health insurance implementation on maternal health service in developing countries, systematically. Subjects and Method: This was a systematic review conducted by searching for articles through three databases, namely Cinahl, Medline, and JSTOR. The search was carried out using the Population, Intervention, Comparison, Outcome, Study Design (PICO-S method). In the identification stage, it was found 251 articles and 8 articles were selected to meet the criteria for this study. Results: The national health insurance system was an effort to ensure that women of reproductive age were able to access quality maternal health services. However, there were still gaps in the utilization of health services which are influenced by factors of education, economic status, and geographic area. Conclusion: The implementation of the national health insurance system has an impact on increasing the utilization of maternal health services, especially in developing countries. Keywords: national health insurance, women of reproductive age, maternal health services, developing country Correspondence: Eva Nur Octavia. Postgraduate of Reproductive Health, Faculty of Public Health, Universitas Indonesia. Jl. Margonda Raya, Pondok Cina, Beji, Depok 16424, East Java. Email: [email protected]. Mobile: +62 87759656772 DOI: https://doi.org/10.26911/the7thicph.04.03

scholarly journals Performance and Attitude of Dental Poly Officers with Patient Satisfaction on JKN Era in Panembahan Hospital Bantul Yogyakarta

2019 ◽  
Vol 6 (2) ◽  
pp. 141-146
Author(s):  
Naufal Rachmanda ◽  
Edi Sumarwanto ◽  
Ayu Kristin Rakhmawati
Keyword(s):  
Patient Satisfaction ◽  
Health Insurance ◽  
Health Services ◽  
National Health Insurance ◽  
National Health ◽  
P Value ◽  
Cross Sectional ◽  
A Value ◽  
Quality Of Health Services

Panembahan Senopati Hospital is a referral hospital. In the government program in the form of the National Health Insurance (JKN), most people who seek treatment at Panembahan Senopati District Hospital have health insurance. The ineffectiveness of the referral system in Indonesia has an impact on the accumulation of patients in advanced health facilities, resulting in a decline in the quality of health services provided. The main indicator of knowing hospital standards is patient satisfaction with services from the hospital. Various facts show that there are serious problems in the quality of health services in Indonesia. This is due to the absence of the best quality control system that can be applied. To determine the level of satisfaction of National Health Insurance (JKN) patients with the quality of health services provided by dental clinic officers at Panembahan Senopati Hospital. Descriptive analytic observational with a cross sectional study design. The population in this study were patients who received dental and oral health services. Samples were taken using 86 accidental sampling techniques. Data was collected using a questionnaire consisting of 14 structured question items based on the performance and attitude of dental clinicians. Data analysis using the Chi-Square test followed by logistic regression test. From the results of multivariate analysis, the P value of 0.035 performance is significant and has a greater chance of 10,588 times compared to performance that is not appropriate. P value of 0.023 attitude is significant and has a 4.315 times the opportunity compared to attitudes that do not include 3 components. Factors related to satisfaction include intelligence, skills. emotional stability, a person's characteristics include attitudes, personal traits, physical traits, desires and motivation. There is a relationship between the performance and attitude of dental clinicians that performance is a variable X which is more influential with a value of P = 0.035 compared with attitude with a value of P = 0.023 to the variable Y about patient satisfaction of dental dentists.

scholarly journals Relationship between Quality of Health Services and Satisfaction of National Health Insurance Participant in the District Hospital of North Buton in 2018

MEDULA ◽  
2019 ◽  
Vol 6 (3) ◽  
Author(s):  
Asmarani Dian Pratiwi ◽  
Nina Indriyani N ◽  
Erik Astrada ◽  
Rhenislawaty Rhenislawaty
Keyword(s):  
Health Insurance ◽  
Health Services ◽  
National Health Insurance ◽  
National Health ◽  
District Hospital ◽  
P Value ◽  
Cross Sectional ◽  
Spearman Rank ◽  
Quality Of Health Services

ABSTRACTLatar Belakang: Kualitas layanan kesehatan merupakan upaya yang dilakukan oleh petugas kesehatan, dokter, perawat, dan paramedis lainnya dalam hal memenuhi kebutuhan dan keinginan pelanggan dan penyediaan pengiriman untuk mengimbangi harapan pelanggan. Kualitas layanan kesehatan  yang  diberikan  terdiri  dari  aspek  bukti  fisik,  keandalan, daya  tanggap,  jaminan  danempati. Tujuan Penelitian: Tujuan penelitian ini adalah untuk mengetahui hubungan kualitas pelayanan kesehatan dengan kepuasan peserta Asuransi Kesehatan Nasional di RSUD Buton Utara. Metode Penelitian: Penelitian ini menggunakan metode analitik-observasional dengan pendekatan cross sectional. Populasi penelitian ini adalah pasien yang berpartisipasi dalam Asuransi Kesehatan Nasional di Rumah Sakit Kabupaten  Buton Utara  dari Agustus hingga September 2018 dengan populasi 64. Dengan sampel 55 sampel diambil menggunakan metode accidental sampling. Data tentang kualitas layanan dan kepuasan pasien diperoleh melalui kuesioner. Analisis data menggunakan metode uji korelasi Spearman rank dan dianggap signifikan jika p <0,05. Hasil Penelitian: Hasil penelitian menunjukkan bahwa ada hubungan yang signifikan antara kualitas layanan dan kepuasan pasien. Hal ini dapat dilihat dari dimensi reliabilitas, yaitu p -value 0,000 (<0,05), dari dimensi responsi yaitu p-value 0,000 (<0,05), dimensi jaminan adalah p-value 0,000 (<0,05)), dan dari dimensi empati itu adalah nilai p-value 0,000 (<0,05) sedangkan pada dimensi buktifisik yang diperoleh p-value adalah 0,000 (<0,05). Dalam penelitian ini diperoleh responden yang menyatakan puas dengan pelayanan kesehatan dengan persentase 80,0% sedangkan mereka yang menyatakan ketidakpuasannya dengan persentase 20,0%. Simpulan: simpulan dari penelitian ini, terdapat hubungan antara kualitas pelayanan dan kepuasan peserta Asuransi Kesehatan Nasional di RSUD Buton Utara. Kata Kunci: bukti fisik, jaminan, keandalan, kepuasan pasien, pasien JKN

scholarly journals Patient’s Satisfaction With Quality of Care at a National Health Insurance Clinic at a Tertiary Center, South-South Nigeria

2021 ◽  
Vol 8 ◽  
pp. 237437352098147
Author(s):  
Temitope Esther Olamuyiwa ◽  
Foluke Olukemi Adeniji
Keyword(s):  
Health Care ◽  
Patient Satisfaction ◽  
Quality Of Care ◽  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
Bivariate Analysis ◽  
P Value ◽  
Tertiary Center

Introduction: Patient satisfaction is a commonly used indicator for measuring the quality of health care. This study assessed patients’ satisfaction with the quality of care at the National Health Insurance Scheme (NHIS) clinic in a tertiary facility. Methods: It was a descriptive cross-sectional study in which 379 systematically selected participants completed an interviewer-administered, semi-structured questionnaire. Data were analyzed using Statistical Package for Social Sciences (SPSS) version 23. Bivariate analysis was performed using Pearson χ2 with a P value set at ≤ .05. Results: The study found out that about half (193, 50.9%) of the respondents were satisfied with the availability of structure. Patients were not satisfied with waiting time in the medical records, account, laboratory, and pharmacy sections. Overall, 286 (75.5%) of the respondents were satisfied with the outcome of health care provided at the NHIS clinic. A statistically significant association ( P = .00) was observed between treatment outcome and patient satisfaction. Conclusion: There is a need to address structural deficiencies and time management at the clinic.

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