ANALYSIS OF THE EFFECT OF DOCTOR'S RESPONSIBILITY AND SOP-SPM KNOWLEDGE ON BPJS KESEHANATN CLAIMS WITH MEDICAL RECORDS MEDIATION

Abstract

The National Health Insurance (JKN) program managed by BPJS Kesehatan (Indonesian Health Insurance Agency) is a major source of hospital revenue, but delays in inpatient claims pose serious financial risks. Bangil Regional Hospital, Pasuruan Regency, shows low initial claims and high follw-up claims, which slows cash flow and reduces efficiency. The underlying factor is the delay in returning medical records by the doctor in charge of the service. This study examines the effect of doctor responsibility and knowledge of SOPs/SPM on the quantity of BPJS Kesehatan claims, with the promptness of medical record return as a mediating variable. This study is an explanatory research study using SEM PLS with 54 samples (Doctors, Medical Records Officers, and BPJS Claims Management Officers) at Bangil Regional Hospital in Pasuruan. The results of this study directly show: 1) Doctors' responsibility plays a role in the number of BPJS Health claim files, 2) Doctors' knowledge of Standard Operating Procedures (SOP) and Minimum Service Standards (SPM) does not play a role in the number of BPJS Health claim files, 3) Timeliness of returning medical records plays a role in the number of BPJS Health claim files, 4) Doctors' responsibility plays a role in the timeliness of returning medical records, 5) Knowledge of SOP-SPM plays a role in the timeliness of returning medical records, 6) Timeliness of returning medical records does not play a significant role as a mediator in the relationship between doctors' responsibility and knowledge of SOP-SPM on the number of BPJS Health claim files.