Academia Open
Vol 9 No 1 (2024): June

Reducing Pending BPJS Claims Through Risk Management

Fitri Hariyanti (Universitas Muhammadiyah Sidoarjo)
Cholifah Cholifah (Universitas Muhammadiyah Sidoarjo)

Article Info

Publish Date
17 May 2024

Abstract

Pending BPJS claims delay hospital payments, with the guarantee unit playing a crucial role. This study analyzes risk management in the guarantee unit regarding pending inpatient claims using a qualitative approach and the FMEA method. Data from interviews, questionnaires, and BPJS claim confirmation sheets revealed four potential risks causing pending claims, with readmission potential as the highest priority (RPN score of 75). The proposed improvements include coordinating, socializing, and educating related units on the readmission concept. Implementing these strategies can reduce pending claims, ensuring timely BPJS payments to hospitals. Highlight: Identified four risks causing pending claims. Readmission risk prioritized (RPN score 75). Education and coordination proposed to reduce claims. Keyword: BPJS claims, risk management, guarantee unit, FMEA, readmission

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Journal Info
Academia Open
Website

Abbrev

acopen

Publisher

Universitas Muhammadiyah Sidoarjo

Subject

Agriculture, Biological Sciences & Forestry Arts Humanities Chemistry Computer Science & IT Earth & Planetary Sciences Economics, Econometrics & Finance Environmental Science Languange, Linguistic, Communication & Media Law, Crime, Criminology & Criminal Justice Library & Information Science Medicine & Pharmacology Physics Social Sciences Other

Description

Academia Open is published by Universitas Muhammadiyah Sidoarjo published 2 (two) issues per year (June and December). This journal provides immediate open access to its content on the principle that making research freely available to the public supports a greater global exchange of knowledge. This ...