Claim Analysis of Cost Reimbursement COVID-19 Patient Service to Badan Penyelenggara Jaminan Sosial (BPJS) in health by Hospital
Abstract
The BPJS COVID-19 fee claim is the government's support in accelerating the handling of COVID-19 in Indonesia. BPJS Health data from January to October 2021, the submission of claims for COVID-19 reached 1,345,970 cases with a cost value of 72.3 trillion IDR. Of the claims submitted by the hospital, only 79.07% were following BPJS claim verification or equivalent to 64.1 trillion IDR. There are still 21% of COVID-19 cost claims that require clarification on dispute resolution. Therefore, it is necessary to study the COVID-19 cost claim according to the provisions and find out the obstacles that occur in submitting BPJS claims by hospitals. The method used is descriptive-analytic by using literature searches, reading materials, and scientific journals. The results obtained are that the claim for COVID-19 costs uses the provisions of the tariff per day/cost per day which is regulated in the technical instructions for claiming reimbursement of costs for COVID-19 patient services number HK.01.07/MENKES/5673/2021. The conclusion obtained is that there are still problems with COVID-19 cost claims in the administrative aspect, the limitations of the verifier team, and the integration of the claim submission system.
Abstrak: Klaim biaya BPJS COVID-19 merupakan dukungan pemerintah dalam percepatan penanganan COVID-19 di Indonesia. Data BPJS Kesehatan Januari-Oktober 2021, pengajuan klaim COVID-19 mencapai 1.34.970 kasus dengan nilai biaya mencapai Rp. 72,3 triliun. Dari pengajuan klaim yang diajukan rumah sakit hanya 79.07% yang sesuai verifikasi klaim BPJS atau setara dengan Rp. 64,1 triliun. Masih ada 21% klaim biaya COVID-19 yang membutuhkan klarifikasi penyelesaian dispute. Oleh karena itu perlu pengkajian mengenai klaim biaya COVID-19 sesuai ketentuan dan mengetahui hambatan yang terjadi dalam pengajuan klaim BPJS oleh rumah sakit. Metode yang digunakan adalah deskriptif analitik dengan menggunakan penelusuran literatur, bahan bacaan dan jurnal ilmiah. Hasil yang diperoleh bahwa klaim biaya COVID-19 menggunakan ketentuan tarif per hari/cost per day yang diatur dalam petunjuk teknis klaim penggantian biaya pelayanan pasien COVID-19 nomor HK.01.07/MENKES/5673/2021. Kesimpulan yang didapat adalah masih ditemukan masalah klaim biaya COVID-19 dalam aspek administrasi, keterbatasan tim verifikator dan integrasi sistem pengajuan klaim.
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References
An, X., Xiao, L., Yang, X., Tang, X., Lai, F., & Liang, X. H. (2022). Economic burden of public health care and hospitalisation associated with COVID-19 in China. Public Health, 203, 65–74. https://doi.org/10.1016/j.puhe.2021.12.001
Arikusnadi, N., Sudirman, S., & Kadri, A. (2020). Studi Penyebab Pengembalian Berkas Klaim Bpjs Kesehatan Di Rumkit Bhayangkara Palu. Jurnal Kolaboratif Sains, 03(1), 159–165.
Borno, H. T., Lin, T. K., Zhang, S., Skafel, A., Lalanne, A., Dornsife, D., Johnson, R., Spicer, D., Small, E. J., & Rhoads, K. F. (2021). Accelerating cancer clinical trial recruitment through a financial reimbursement program integrated with patient navigation: an interrupted time series analysis. Journal of Cancer Policy, 30(May), 100305. https://doi.org/10.1016/j.jcpo.2021.100305
BPJS Kesehatan. (2014). Panduan Praktis Teknis Verifikasi Klaim (BPJS Keseh).
BPJS Kesehatan. (2019). INFO BPJS Kesehatan (99th ed.).
BPJS Kesehatan. (2021). Panduan praktis Administrasi Klaim Fasilitas Kesehatan BPJS Kesehatan.
Choi, S. E., Simon, L., Basu, S., & Barrow, J. R. (2021). Changes in dental care use patterns due to COVID-19 among insured patients in the United States. Journal of the American Dental Association, 152(12), 1033-1043.e3. https://doi.org/10.1016/j.adaj.2021.07.002
Diel, R., & Nienhaus, A. (2022). Point-of-care COVID-19 antigen testing in German emergency rooms – a cost-benefit analysis. Pulmonology, 28(3), 164–172. https://doi.org/10.1016/j.pulmoe.2021.06.009
Direktorat Penyusunan Anggaran APBN. (2020). Pokok-Pokok APBN 2020. Kementerian Keuangan R.I.
EP, A. (2018). Faktor-Faktor Penyebab Klaim Tertunda BPJS Kesehatan RSUD Dr. Kanujoso Djatiwibowo Periode Januari-Maret 2016. Jurnal Administrasi Rumah Sakit, 4(2), 122–134. http://journal.fkm.ui.ac.id/arsi/article/view/2564
Ettinger, R., Marchini, L., & Zwetchkenbaum, S. (2022). The Impact of COVID-19 on the Oral Health of Patients with Special Needs. Dental Clinics of North America, 66(2), 181–194. https://doi.org/10.1016/j.cden.2022.01.001
Hare, N., Bansal, P., Bajowala, S. S., Abramson, S. L., Chervinskiy, S., Corriel, R., Hauswirth, D. W., Kakumanu, S., Mehta, R., Rashid, Q., Rupp, M. R., Shih, J., & Mosnaim, G. S. (2020). Work Group Report: COVID-19: Unmasking Telemedicine. Journal of Allergy and Clinical Immunology: In Practice, 8(8), 2461-2473.e3. https://doi.org/10.1016/j.jaip.2020.06.038
Hsu, J. (2022). Personalized Digital Health Beyond the Pandemic. Journal for Nurse Practitioners, xxxx. https://doi.org/10.1016/j.nurpra.2022.04.022
Iorio, R., Anoushiravani, A. A., Stronach, B. M., Barnes, C. L., Zhang, X., & Haas, D. A. (2022). The COVID-19 Pandemic and Centers of Medicaid and Medicare Services Regulatory Reform Impact on Total Hip Arthroplasty Metrics. The Journal of Arthroplasty, 37(7), S408–S412. https://doi.org/10.1016/j.arth.2022.02.101
Kemenkeu. (2021). Anggaran Pendapatan dan Belanja Negara 2021. Kementerian Keuangan Direktorat Jenderal Anggaran.
Kementerian Kesehatan RI. (2021a). Keputusan menteri kesehatan republik indonesia nomor HK.01.07/menkes/4718/2021 tentang petunjuk teknis klaim penggantian biaya pelayanan pasien (Petunjuk T).
Kementerian Kesehatan RI. (2021b). Keputusan Menteri Kesehatan Republik Indonesia Nomor HK.01.07/Menkes/5673/2021 Tentang Petunjuk Teknis Klaim Penggantian Biaya Pelayanan Pasien Corona Virus Disease 2019 (Covid-19).
Kementerian Kesehatan RI. (2021c). Pedoman Pelayanan Rumah Sakit Pada Masa Pandemi COVID-19 (Revisi 1). Direktorat Jenderal Pelayanan Kesehatan.
Miller, L. H., Parks, J., & Yowell, R. (2022). The Impact of COVID-19 on Financing of Psychiatric Services. Psychiatric Clinics of North America, 45(1), 161–177. https://doi.org/10.1016/j.psc.2021.11.014
Qiu, T., Wang, Y., Liang, S., Han, R., & Toumi, M. (2021). The impact of COVID-19 on the cell and gene therapies industry: Disruptions, opportunities, and future prospects. Drug Discovery Today, 26(10), 2269–2281. https://doi.org/10.1016/j.drudis.2021.04.020
Satuan Tugas Penanganan COVID-19. (n.d.). Peta sebaran covid-19. https://covid19.go.id/peta-sebaran-covid19
Sekretariat Negara RI. (2020). KEPRES RI No. 7 Tahun 2020 Tentang Gugus Tugas Percepatan Penanganan Corona Virus Disease 2019 (Covid-19).
Setyawan, F. (2015). Sistem Pembiayaan Kesehatan. Sistem Pembiayaan Kesehatan. 11, 119–126. https://doi.org/10.1038/271360a0
Smith, S. J., Smith, A. Ben, Kennett, W., & Vinod, S. K. (2022). Exploring cancer patients’, caregivers’, and clinicians’ utilisation and experiences of telehealth services during COVID-19: A qualitative study. Patient Education and Counseling, June. https://doi.org/10.1016/j.pec.2022.06.001
Spence, R., Sisson, E. M., & Dixon, D. L. (2022). Survey of CDC-recognized community pharmacies providing the National Diabetes Prevention Program and impact of the COVID-19 pandemic on program delivery. Journal of the American Pharmacists Association, 1–6. https://doi.org/10.1016/j.japh.2022.03.020
Treitler, P. C., Bowden, C. F., Lloyd, J., Enich, M., Nyaku, A. N., & Crystal, S. (2022). Perspectives of opioid use disorder treatment providers during COVID-19: Adapting to flexibilities and sustaining reforms. Journal of Substance Abuse Treatment, 132(May 2021), 108514. https://doi.org/10.1016/j.jsat.2021.108514
van Kessel, R., Wong, B. L. H., Clemens, T., & Brand, H. (2022). Digital health literacy as a super determinant of health: More than simply the sum of its parts. Internet Interventions, 27(January), 100500. https://doi.org/10.1016/j.invent.2022.100500
Wahezi, S. E., Kohan, L. R., Spektor, B., Brancolini, S., Emerick, T., Fronterhouse, J. M., Luedi, M. M., Colon, M. A., Kitei, P. M., Anitescu, M., Goeders, N. E., Patil, S., Siddaiah, H., Cornett, E. M., Urman, R. D., & Kaye, A. D. (2021). Telemedicine and current clinical practice trends in the COVID-19 pandemic. Best Practice and Research: Clinical Anaesthesiology, 35(3), 307–319. https://doi.org/10.1016/j.bpa.2020.11.005
Waitzberg, R., Gerkens, S., Dimova, A., Bryndová, L., Vrangbæk, K., Jervelund, S. S., Birk, H. O., Rajan, S., Habicht, T., Tynkkynen, L. K., Keskimäki, I., Or, Z., Gandré, C., Winkelmann, J., Ricciardi, W., de Belvis, A. G., Poscia, A., Morsella, A., Slapšinskait?, A., … Quentin, W. (2021). Balancing financial incentives during COVID-19: A comparison of provider payment adjustments across 20 countries. Health Policy, 126, 398–407. https://doi.org/10.1016/j.healthpol.2021.09.015
Wong, B. L. H., Maaß, L., Vodden, A., van Kessel, R., Sorbello, S., Buttigieg, S., & Odone, A. (2022). The dawn of digital public health in Europe: Implications for public health policy and practice. The Lancet Regional Health - Europe, 14, 100316. https://doi.org/10.1016/j.lanepe.2022.100316
World Health Organization. (2020). International Guidelines for Certification and Classification (Coding) of Covid-19 as Cause of Death. WHO, April, 14. https://www.who.int/classifications/icd/Guidelines_Cause_of_Death_COVID-19.pdf
World Health Organization. (2021). WHO Coronavirus (COVID-19) Dashboard. https://covid19.who.int/
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