OVERVIEW OF POST-CLAIM VERIFICATION AND ADMINISTRATIVE AUDIT OF NATIONAL HEALTH INSURANCE AT SURYA HUSADHA GENERAL HOSPITAL, DENPASAR

Abstract

Medical records are available on time is the quality of medical records. The time of provision of medical records is a service problem at Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar. This study identifies factors that influence the delay in providing medical records for polyclinic patients during the admission process according to Lawrence Green's theory (predisposing factors (knowledge and attitude), enabling factors (facilities and infrastructure), reinforcing factors (training and SOP)). The following qualitative research methods are observations and documentation of interview results. The results of the study showed the unpreparedness of the knowledge and attitude of admission officers in carrying out service procedures where the time for providing medical records ranges from 30 minutes to 1x24 hours which has an impact on the delay in patient treatment and care. Adjustment of manual data and EMR extends the completion time of patient admission. Another problem found is that polyclinic doctors and nurses have not completed the EMR data so that the data presentation is not up to date. The availability of resources plays an important role, predisposing factors are connected to enabling factors from the division of tasks and authority of officers, knowledge and attitudes affect the activity process (reinforcing factors). Conclusion: officers do not yet know the procedures related to the response time for receiving medical records for admission, studies and evaluations have never been conducted in the admission unit (enabling factor), the need for EMR training and socialization of SOPs (reinforcing factor). Hospitals are advised to maximize EMR in patient admission, EMR training and socialization of patient admission policies