Mentoring for the Integration of Quality Management and Financial Control at PKU Sekapuk Hospital
DOI:
https://doi.org/10.61181/ya4pxp11Keywords:
Clinical Pathway, Cost Containment, Dispute ClaimAbstract
The financial dependence of regional private hospitals on claims from the Badan Penyelenggara Jaminan Sosial Kesehatan (BPJS Kesehatan) demands a robust daily revenue cycle. Internal coordination at PKU Sekapuk Hospital in Lamongan is reactive, limited to post-claim rejection issues, without integrated guidance documents, leading to high claim dispute rates and cost leakage. Community Empowerment Program (CEP) aims to secure the hospital’s cash flow through synchronized quality control and cost control. The method used is a multidisciplinary reconciliation workshop and collaborative medical record audit, bringing together the Medical Committee (Doctors) and the Administrative Team (Coders/Finance) based on the BPJS Balanced Hospital Operating Model Framework. This CEP successfully formulated a formal Clinical Pathway Blueprint document for the 10 diagnoses with the highest case volume. The implementation results have proven effective in controlling unnecessary variations in medical operational costs through standardized drug formularies and increasing the net claim acceptance rate above 95%. This document serves as the final pillar of a holistic solution to boost the hospital’s financial competitiveness.
References
Dinas Kesehatan Kabupaten Lamongan, Laporan Kinerja Instansi Pemerintah (LKjIP) Dinas Kesehatan Kabupaten Lamongan (Lamongan: Dinas Kesehatan Kabupaten Lamongan., 2024).
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Yulitha Firdaus and Yanuar Ramadhan, “Analisis Perbandingan Tarif Rumah Sakit, Tarif INA-CBG’s, Dan Unit Cost Berbasis Clinical Pathway Menggunakan Metode ABC Pada Tindakan Persalinan Di Rumah Sakit Ibu Dan Anak Kota Tangerang,” Jurnal Ilmiah MEA (Manajemen, Ekonomi, Dan Akuntansi) 8, no. 3 (2024): 55–73.
Y. Firmansyah and G. Widjaja, “Pemberlakuan Clinical Pathway Dalam Pemberian Layanan Kesehatan Dan Akibat Hukumnya,” Jurnal Medika Hutama 3, no. 2 (2022): 1–38.
Yulitha Firdaus and Yanuar Ramadhan. Ibid.
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