Utilization Review: Penilaian Komitmen Dan RSUD Selasih

Penilaian Komitmen dan Utilization
Review RSUD Selasih
Darmayanti Utami
Kepala Bidang PMR Cabang Pekanbaru
Kantor Cabang Pekanbaru

HOSPITAL REPORT
KEPATUHAN FASKES TERHADAP KONTRAK
TAHUN 2020 (e-Komit)
Definisi
Tingkat Kepatuhan terhadap Kontrak adalah indikator yang digunakan dalam
mengukur tingkat kepatuhan Fasilitas Kesehatan terhadap Perjanjian Kerja Sama
Indikator : Target : Sumber Data :

1. Display Ketersediaan Tempat Tidur Yang 40 FKRTL Aplicares
Terhubung Dengan Aplicares
Aplikasi SIPP, Lapor!, Care Center

2. Keluhan Peserta Terkait Iur Biaya Tidak Ada Keluhan 1500400  Indeks Kepatuhan 87
3. Keluhan Peserta Terkait Diskriminasi Aplikasi SIPP, Lapor!, Care Center  Indeks menjadi dasar
Pelayanan Tidak Ada Keluhan 1500400 asesmen
4. Keluhan Peserta Terkait Kuota Kamar Aplikasi SIPP, Lapor!, Care Center rekredensialing
Perawatan Tidak Ada Keluhan 1500400
5. Updating Rutin Ketersediaan TT Update Aplicares
6. Angka Rujuk Balik 100% dari target PRB 100% dari target Data SSBI
PRB
3
PENILAIAN s.d. BULAN PELAYANAN JUNI 2020
INDIKATOR
April -20 Mei-20 Juni-20
PERFORMA
Hasil Survey WTA 0% 0% 84%
Kepatuhan
Faskes terhadap 77.7% 77.7% 77.9%
kontrak
Catatan Sanksi
0 0 0
Pelanggaran
Display TT
0 0 0
Antrian online
Hasil Rekredensialing 82
Penilaian kepatuhan tidak 100%, pencapaian
(Direkomendasikan)
display TT dan PRB belum tercapai
4
PENILAIAN WTA RAWAT JALAN
s.d JUNI 20
RSUD SELASIH
Administrasi Rumah Dokter Anda Pelayanan di Waktu tunggu antrian Petugas Petugas Rumah Dokter Anda puas
Pendaftaran di sakit spesialis mendapatkan Rumah Sakit pendaftaran rawat Rumah Sakit Sakit memberikan dengan
Rumah Sakit memberik datang seluruh obat- tidak dikenakan jalan di Rumah Sakit ini (petugas memberikan penjelasan/ pelayanan di
mudah (tidak an sesuai obatan sesuai biaya tambahan kurang atau selama administrasi, informasi dan informasi Rumah Sakit
memerlukan pelayanan jadwal poli yang diresepkan (kecuali poli satu jam (Waktu yang dokter dan menangani dengan baik ini
fotocopy berkas yang sama oleh dokter eksekutif atau diperlukan mulai dari perawat) keluhan Anda terkait
kartu/KK/KTP) untuk atas permintaan pasien mendaftar bersikap dengan baik penyakit
semua sendiri) antrian di Petugas ramah dalam Anda
Bulan pasien checker eligibilitas melayani Anda
Responden % Total Nilai
Pelayanan untuk mendapat nomor
eligibilitas (SEP) sampai
dilayani oleh Dokter
Spesialis)
Januari 20
74 81 74 83 81 82 83 87 89 89 82
Februari 20 32
Maret 20
April 20
Mei 20
67 84 71 83 81 82 86 86 83 83 81
Juni 20 68
Skor WTA > 85
5
PENILAIAN WTA RAWAT INAP
s.d JUNI 20
RSUD SELASIH
Rumah Sakit Dokter Mendapatka Pelayanan di Rumah Sakit Mudah mendapatkan Petugas Petugas Dokter Anda puas % Total
memberikan mengunju n seluruh Rumah Sakit memiliki petunjuk kamar rawat inap di Rumah Sakit Rumah sakit memberikan dengan Penilaian
pelayanan yang ngi/ visite obat-obatan tanpa biaya yang jelas Rumah Sakit (petugas memberikan penjelasan/ pelayanan di
sama untuk semua setiap hari sesuai yang tambahan tentang informasi administrasi, informasi dan informasi Rumah Sakit
Bulan pasien saat di diresepkan (kecuali jika naik ketersediaan dokter dan menangani dengan baik ini
Responden
Pelayanan rawat inap oleh dokter kelas atas kamar rawat inap perawat) keluhan tentang
permintaan bersikap dengan baik penyakit
sendiri) ramah dalam
melayani)
Januari 20
80 80 80 80 100 100 100 100 100 92
Februari 20 1 100
Maret 20
April 20
Mei 20
85 81 85 90 86 88 90 88 87 88 87
Juni 20 22
Skor WTA > 85
6
CAPAIAN PRB
April 20 Mei 20 Juni 20

Akumulasi Rekrutmen Mei Rekrutmen
Nama Faskes Target 2020 20 Juni 20 %
Capaian 2019 s.d Total
April 2020
RSUD SELASIH 292 - 3 295

330 89.39%
 Capaian PRB
100% dari Target
PRB
7
CAPAIAN KEPATUHAN
 Indeks Capaian
Kepatuhan > 87
8
Biaya Pelkes s.d Bupem
Juni 2020
Jenis Pelayanan Des-19 Jan-20 Feb-20 Mar-20 Apr-20 Mei-20 Jun-20

CBG RITL Rp 9,613,754,700 Rp 853,478,600 Rp 899,355,900 Rp 793,645,200 Rp 827,384,900 Rp 884,965,400 Rp 635,747,200
CBG RJTL Rp 8,743,598,100 Rp 719,334,500 Rp 747,458,100 Rp 895,944,200 Rp 665,331,200 Rp 970,386,200 Rp 326,247,100
OBAT RJTL Rp 49,206,118 Rp 12,304,116 Rp 3,255,854 Rp - Rp 10,137,551 Rp - Rp 49,008,505
ALKES Rp 23,850,000 Rp 3,850,000 Rp 1,200,000
Total Rp 18,430,408,918 Rp 1,588,967,216 Rp 1,651,269,854 Rp 1,689,589,400 Rp 1,502,853,651 Rp 1,855,351,600 Rp 1,011,002,805
Sumber: SE33 bupem Juni 2020
www.bpjs-kesehatan.go.id
Absensi Klaim s.d Bupem Juni 2020
JUMLAH BULAN ABSENSI KLAIM

RUMAH SAKIT
PELAYANAN N -1 % N -2 % N > 3 %
RSUD SELASIH 6 0 0% 6 100% 0 0%
Kualitas Klaim
Bupel SEP Bayar SEP Terbit % Bupel SEP Bayar SEP Terbit %
Jan-19 2625 2,779 94% Jan-19 239 251 95%
Feb-19 2280 2,431 94% Feb-19 201 211 95%
Mar-19 2339 2,498 94% Mar-19 184 197 93%
Apr-19 2297 2,464 93% Apr-19 175 190 92%
Mei-19 2294 2,435 94% Mei-19 175 192 91%
Jun-19 1549 1,672 93% Jun-19 150 159 94%
Jul-19 2737 2,921 94% Jul-19 222 240 93%
Agu-19 2324 2,487 93% Agu-19 210 231 91%
Sep-19 2087 2,249 93% Sep-19 188 210 90%
Okt-19 2299 2,508 92% Okt-19 228 261 87%
Nov-19 2021 2,261 89% Nov-19 186 254 73%
Des-19 2139 2,324 92% Des-19 221 277 80%
Jan-20 2,530 2,719 93% Jan-20 275 301 91%
Feb-20 2,294 2,492 92% Feb-20 185 258 72%
Mar-20 2,050 2,197 93% Mar-20 182 248 73%
Apr-20 840 1,047 80% Apr-20 118 171 69%
Mei-20 608 785 77% Mei-20 94 164 57%
Jun-20 0 545 0% Jun-20 0 71 0%
Sumber: bi tanggal 11 Juli 2020
Claim Review Tahun 2020
NO JENIS PENDING URAIAN TKP 20-Jan 20-Feb 20-Mar 20-Apr Mei-20 Jun-20
1 Administrasi konfirmasi ada perbedaan tgl dan wkt antara laporan IGD, lap.operasi, lap.anastesi dan SEP RITL 2 2
Nama DPJP yang dientry tidak sesuai RITL 1 1
2 Koding Anemia RITL 2 2
Bronkitis RITL 1 1
Chest pain RITL 1 1
CHF RITL 6 4 10
CKD RITL 1 2 3
Cystitis RITL 2 2
Dengue fever RITL 1 2 1 1 5
DM RITL 5 2 7
Dyspepsia RITL 1 1 2
Encepalofati RITL 1 1
GEA RITL 1 1
GERD RITL 1 1
Hepatitis RITL 1 1 2
Hipokalemia RITL 1 1
Hypertensive heart disease with (congestive) heart failure RITL 2 1 3
Hypo-osmolality and hyponatraemia RITL 1 1
Low back pain RITL 1 1
Non-insulin-dependent diabetes mellitus with coma RITL 1 1
Other specified disease and conditions complicating pregnancy, chilbirth ant the puerperium RITL 1 1
Outcomes persalinan RITL 1 1
pneumonia RITL 2 1 1 1 5
Prolonged pregnancy RITL 1 2 3
PPOK RITL 5 4 2 1
TB + pneumonia RITL 1
Tension-type headache RITL 1
Typhoid fever RITL 1
ISK RITL 1 1 1
FRAKTUR RITL 1 3
Ekstrapiramidal syndrom RITL 1
Leukopenia agranulositosis RITL 1
Malnutrisi atau Kaheksia RITL 1
Ensefalopati RITL 1
Diagnosa sekunder tidak diinput. RJTL 1
Asfiksia RITL 1
Bayi dengan berat badan rendah RITL 2 1
Calculus of kidney RITL 1
Cardiact arrest RITL 1
DM RITL 2
Efusi pleura RITL 2
Heart failure RITL 1
Intracerebral haemorrhage, unspecified RITL 1
Septic shock RITL 1
Neoplasma RITL 1
Sepsis RITL 1 1
Stroke RITL 2 4
Excision of ectopic breast tissue RITL 1
Eksisi tanpa PA RITL 4
Exploratory laparotomy pada appendicitis RITL 8
kuretase pada blighted ovum RITL 1 1
Prosedur dan deskripsi tidak sesuai RITL 1
Radical neck dissection, not otherwise specified RITL 1
Repair laserasi persalinan RITL 1
STT superfisial RITL 1 3 3 4
3 Medis Konfirmasi indikasi rawat inap RITL 2 5 4 6 3

Bayi lahir sehat tanpa resourses RITL 7 10 19 10 18
4 Lain-Lain Fragmentasi pelayanan RJTL 19 37 13 6 1
Potensi Readmisi RITL 2
Monitoring Insiden tidak sesuai RJTL 1
Total 65 83 67 38 46
Peraturan Menteri Kesehatan Nomor 16 tahun 2019 tentang Pencegahan dan Penanganan Kecurangan (Fraud)
serta Pengenaan Sanksi Administrasi Terhadap Kecurangan (Fraud) dalam Pelaksanaan Program Jaminan
Kesehatan pada Lampiran Bab II
Sumber: bi tanggal 11 Juli 2020

Tren 4 Pintu Masuk RSUD Selasih 2019 s.d Juni
2020
Sumber Jan-19 Feb-19 Mar-19 Apr-19 Mei-19 Jun-19 Jul-19 Agu-19 Sep-19 Okt-19 Nov-19 Des-19 Rataan 19
Rujukan Antar RS 0.1% 0.4% 0.2% 0.2% 0.2% 0.2% 0.3% 0.2% 0.3% 0.3% 0.4% 0.4% 0.3%
Rujukan FKTP 39.0% 35.8% 34.5% 35.2% 31.3% 37.7% 35.7% 33.1% 32.7% 31.5% 34.8% 35.8% 34.8%
Rujukan Internal 57.9% 60.0% 60.3% 59.1% 64.3% 55.6% 59.9% 61.6% 61.5% 62.6% 59.1% 58.1% 60.0%
UGD 3.0% 3.8% 5.0% 5.4% 4.2% 6.5% 4.0% 5.1% 5.5% 5.6% 5.8% 5.7% 5.0%
Jan-20 Feb-20 Mar-20 Apr-20 Mei-20 Jun-20 Rataan 20

1.0% 0.7% 1.1% 1.1% 0.8% 1.5% 1.0%
38.9% 34.9% 35.6% 31.8% 33.5% 43.1% 36.3%
55.8% 61.2% 58.9% 60.4% 58.2% 50.3% 57.5%
4.3% 3.2% 4.4% 6.7% 7.5% 5.1% 5.2%
Sumber: ssbi tanggal 11 Juli 2020
Asal pintu masuk terbesar adalah Rujukan Internal dengan

rata rata di 2020 57.5 % (rataan KC 63,9 %)
Diagnosa dan Poli tujuan Rujukan Internal
RSUD Selasih s.d Juni 2020
No Nm Diag 2020 No Politujsep 2020

1 Follow-up examination after other treatment for other conditions 543 1 17 5,713
2 Chronic kidney disease, stage 5 200 2 INT 4,626
3 Low back pain 182
3 JAN 3,788
4 Epilepsy 168
4 IRM 2,969
5 Parkinson's disease 165
6 Chronic kidney disease 153 5 HDL 2,864
7 Senile cataract 126 6 SAR 2,839
8 Congestive heart failure 118 7 8 2,373
9 Respiratory tuberculosis, not confirmed bacteriologically or histologically 109 8 30 2,199
10 Non-insulin-dependent diabetes mellitus with unspecified complications 93 9 ORT 2,102
11 Sciatica 93 10 21 1,307
12 Non-insulin-dependent diabetes mellitus with neurological complications 89
13 Thyrotoxicosis [hyperthyroidism] 76
14 Cerebral infarction, unspecified 75
15 Respiratory tuberculosis, bacteriologically and histologically confirmed 63
16 Heart failure 61
17 Cataract, unspecified 58
18 Heart failure, unspecified 57
19 Intervertebral disc disorder, unspecified 55
20 Non-insulin-dependent diabetes mellitus 53
21 Disorder of refraction, unspecified 53
Peraturan Terkait Rujukan Internal
 Rujukan Internal adalah rujukan horizontal konsultasi medis oleh dokter penanggung jawab
pasien (DPJP) utama kepada dokter spesialis atau sub spesialis lain atas penyakit
pasiennya dalam satu Rumah Sakit yang sama.
 Rujukan internal diberikan oleh DPJP bila diperlukan konsultasi dengan spesialis atau
subspesialis lain atas penyakit pasien atau poli yang berhubungan dengan kondisi
penyakit pasien.
 Ketentuan masa berlaku rujukan awal mengikuti ketentuan rujukan yang berlaku saat ini (90
hari)
16
Kunjungan berulang rjtl 2020
Frekuensi Kunjungan
Poli Tuj SJP
1 2 3 4 5 6 7 8 9 10 11 12 13
ANA 170 36 12 4 1 1 1
BED 253 42 9 3 2
GIG 78 14 9 1
HDL 6 1 2 5 10 11 2 1 1
IGD 98 8 2
INT 488 216 120 96 25 4 1 1
IRM 34 22 15 19 10 6 5 3
KLT 12 2 2
MAT 560 121 28 5 4 3
OBG 133 3
PAR 260 97 19 1
SAR 254 100 77 45 19 5 1 1
THT 32 5 1 1

Kunjungan berulang rjtl per Peserta Poli Dalam
No Poli No KA Pst Jan-19 Feb-19 Mar-19 Apr-19 Mei-19 Jun-19 Jul-19 Agu-19 Sep-19 Okt-19 Nov-19 Des-19 Jan-20 Feb-20 Mar-20 Apr-20 Mei-20 Total
1 INT 229977491 4 3 4 5 4 3 5 4 4 5 4 4 4 4 4 61
2 INT 49961171 5 4 4 4 3 5 4 3 5 4 4 4 3 5 57
3 INT 4884394 4 3 4 5 3 5 4 3 4 4 4 4 4 5 56
4 INT 72886070 4 3 4 5 4 5 4 4 5 4 4 3 4 53
5 INT 49634496 4 4 4 4 4 5 4 5 4 3 4 4 4 53
6 INT 104282612 3 5 4 3 4 3 3 4 4 3 4 4 5 4 53
7 INT 92788048 3 3 4 4 4 3 4 3 3 4 4 3 3 45
8 INT 90182238 4 5 4 5 4 4 3 3 4 4 5 45
9 INT 3031429 4 2 2 3 5 3 5 2 4 4 3 4 4 45
10 INT 29669275 4 3 4 4 4 3 4 4 4 4 4 3 45
11 INT 27100006 2 4 3 3 3 5 2 5 4 4 3 3 4 45
12 INT 13301891 5 4 3 5 4 4 4 4 4 4 4 45
13 INT 83331130 3 4 3 3 3 4 4 3 4 4 4 5 44
14 INT 229063547 3 3 5 4 4 3 4 3 4 4 3 3 43
15 INT 18182345 4 3 4 5 4 3 5 4 4 4 3 43
16 INT 69058484 3 4 4 3 3 3 3 4 5 3 4 3 42
17 INT 101100765 4 3 4 4 3 4 1 4 4 3 4 4 42
18 INT 12007245 5 3 3 4 4 4 5 4 4 5 41
19 INT 97324388 1 2 4 3 5 4 3 4 4 4 3 3 40
20 INT 96828676 3 3 4 4 4 5 3 4 3 3 4 40
21 INT 236838397 3 3 3 3 3 3 4 3 3 4 4 4 40
22 INT 20545923 4 3 3 4 5 4 3 4 3 3 4 40
23 INT 1488205 4 3 4 3 3 5 3 4 4 3 4 40
24 INT 12701044 3 4 4 5 4 5 4 3 3 4 39
25 INT 11243815 3 4 5 3 4 4 3 4 4 5 39
26 INT 88557906 5 3 3 4 3 5 4 3 4 4 38
27 INT 121116559 5 4 4 3 4 3 4 4 3 4 38
28 INT 90168427 4 4 4 5 3 5 4 4 4 37
29 INT 85408345 4 4 5 4 4 3 3 4 3 3 37
30 INT 69172263 3 3 4 3 3 3 4 4 5 4 36
31 INT 239001961 4 3 5 4 4 4 3 4 5 36

Kunjungan berulang rjtl per Nomor Kartu Penyakit
Dalam
32 INT 53344503 4 4 5 4 4 4 3 3 4 35
33 INT 48082519 5 3 4 2 3 4 4 5 3 33
34 INT 116207503 5 4 5 4 5 3 4 3 33
35 INT 2287509 3 3 2 3 4 3 2 3 3 4 2 32
36 INT 17745721 4 3 4 4 4 4 4 3 2 32
37 INT 121125289 5 4 3 5 4 3 5 3 32
38 INT 86555823 4 5 4 3 3 4 4 3 30
39 INT 71917761 3 4 5 3 4 3 4 4 30
40 INT 65998550 4 4 4 5 4 5 4 30
41 INT 69396587 2 3 3 3 4 4 4 3 3 29
42 INT 28855467 4 3 3 3 3 5 4 4 29
43 INT 16746067 3 5 4 3 4 4 3 3 29
44 INT 107275469 5 4 5 4 4 4 3 29
45 INT 97004383 3 3 3 3 5 4 3 4 28
46 INT 88223468 4 4 3 4 3 3 4 3 28
47 INT 53802711 4 4 4 3 5 3 5 28
48 INT 49788769 4 4 5 4 4 4 3 28
49 INT 75678720 5 4 4 4 4 3 3 27
50 INT 3866996 3 3 4 4 4 4 5 27
51 INT 239492718 4 3 4 4 3 4 5 27
52 INT 237054618 5 4 4 3 4 4 3 27
53 INT 102175325 3 4 4 3 4 3 2 4 27
54 INT 91487335 4 4 4 3 3 4 4 26
55 INT 46063664 3 4 4 3 5 4 3 26
56 INT 121080851 3 4 4 3 5 3 3 1 26
57 INT 16658384 3 3 3 4 3 5 4 25
58 INT 32651767 1 3 4 5 3 3 5 24
59 INT 215597670 4 4 4 4 4 4 24
60 INT 21419034 2 3 4 4 4 3 4 24
61 INT 89196403 3 5 3 5 3 4 23
62 INT 82387822 5 4 1 3 4 3 3 23
63 INT 53388614 3 3 5 4 4 4 23
64 INT 102350160 5 3 4 3 5 3 23
65 INT 88567272 4 4 5 4 4 1 22
66 INT 81637356 4 4 4 3 3 4 22
67 INT 66382239 4 3 3 3 3 3 3 22
68 INT 34086103 4 4 4 3 3 4 22
69 INT 31897581 3 2 3 4 4 3 3 22
70 INT 203743571 2 3 5 4 1 2 2 3 22

Kunjungan berulang rjtl per Nomor Peserta
Poli Saraf
1 SAR 28660118 5 4 4 3 5 3 4 5 4 4 4 3 5 4 3 5 65
2 SAR 65596033 5 3 5 3 5 3 4 5 3 5 4 3 4 4 5 3 64
3 SAR 78471224 3 3 5 4 4 3 4 5 3 4 4 3 5 4 3 5 62
4 SAR 88567272 5 3 5 3 4 2 4 4 3 4 4 3 4 4 3 3 58
5 SAR 48101627 5 4 4 4 5 3 5 4 4 5 4 3 4 4 58
6 SAR 22542272 4 4 5 4 3 4 4 3 3 5 3 5 3 4 4 58
7 SAR 65616335 3 3 5 4 5 3 4 3 3 4 4 3 5 3 5 57
8 SAR 103532663 4 4 4 3 4 3 4 4 3 4 4 3 5 4 4 57
9 SAR 101094051 4 4 4 3 4 3 5 4 5 3 3 4 4 3 4 57
10 SAR 22804603 5 4 4 4 5 3 4 4 3 5 3 4 4 3 55
11 SAR 39014378 5 4 4 3 3 5 4 4 4 2 3 5 4 4 54
12 SAR 19239276 4 4 4 5 4 3 5 3 5 3 4 4 5 53
13 SAR 106403062 5 4 4 4 5 3 4 4 4 4 4 3 5 53
14 SAR 38799384 1 4 4 2 5 3 5 4 3 4 4 5 4 48
15 SAR 43173217 4 4 4 3 4 3 4 5 3 3 3 3 43
16 SAR 89706228 5 4 4 4 5 5 3 4 3 3 40
17 SAR 31829358 4 4 4 5 4 3 5 4 3 3 39
18 SAR 82918727 4 3 4 4 4 3 3 3 3 4 3 38
19 SAR 93763329 3 3 3 3 4 2 4 3 3 3 2 2 2 37
20 SAR 30445957 4 4 3 4 4 4 3 3 4 3 36
21 SAR 52923705 4 5 4 3 4 4 4 3 3 34
22 SAR 92923367 4 3 4 4 3 3 4 4 3 32
23 SAR 197101397 5 4 4 3 5 3 4 3 31
24 SAR 17745585 3 4 4 4 3 5 4 4 31
25 SAR 76351317 5 4 4 4 5 3 5 30
26 SAR 237040244 3 5 4 4 3 3 4 4 30
27 SAR 65715775 5 3 5 3 3 3 4 3 29
28 SAR 31897581 4 4 1 2 4 2 4 3 4 28

Kunjungan berulang rjtl Paru
1 PAR 190567562 2 3 5
2 PAR 9059573 3 3
3 PAR 28386433 3 3
4 PAR 168710437 3 3
5 PAR 23133110 2 2
6 PAR 75166736 4 3 3 3 3 5 3 3 4 3 34
7 PAR 236838441 4 3 4 3 4 3 4 25
8 PAR 29878527 4 3 4 3 4 3 21
9 PAR 107485461 4 3 3 3 4 4 21
10 PAR 77267044 5 3 3 4 5 20
11 PAR 121108559 3 4 5 4 4 20
12 PAR 4465018 3 3 3 4 3 3 19
13 PAR 26806449 3 4 3 3 13
14 PAR 77946641 3 3 3 3 12
15 PAR 238157642 3 3 3 3 12
16 PAR 97341810 3 2 2 4 11
17 PAR 52152137 3 4 3 10
18 PAR 429316 3 3 4 10
19 PAR 31156584 4 3 3 10
20 PAR 26271343 2 4 4 10
21 PAR 15164645 4 3 3 10
22 PAR 60868131 3 3 3 9
23 PAR 224297807 3 3 3 9
24 PAR 224297804 3 3 3 9
25 PAR 97324388 2 2 1 1 1 1 8
26 PAR 91342671 5 3 8
27 PAR 229995137 4 4 8
28 PAR 80267044 4 3 7
29 PAR 36994569 4 3 7
30 PAR 229063547 2 2 1 2 7

TREND Biaya Pelkes RJTL TAHUN 2019 s.d April 2020
BuPel Biaya Kasus Unit Cost

2019 1 793.958.500 2.616 303.501
2019 2 710.959.300 2.268 313.474
2019 3 751.056.100 2.333 321.927
2019 4 781.910.800 2.291 341.297
2019 5 635.935.700 2.258 281.637
2019 6 592.437.500 1.537 385.451
2019 7 903.305.900 2.695 335.178
2019 8 819.210.000 2.298 356.488
2019 9 601.141.600 2.069 290.547
2019 10 824.521.700 2.290 360.053
2019 11 748.606.300 2.044 366.246
2019 12 741.340.100 2.159 343.372
2020 1 890.394.200 2.441 364.766
2020 2 664.475.500 2.284 290.926
2020 3 919.909.700 2.047 449.394
Sumber: ssbi tanggal 11 Juli 2020 2020 4 321.937.800 840 383.259
Rataan 721.934.667 2.080 350.610
TREND Biaya Pelkes RJTL TAHUN 2019 s.d April 2020

TREND KASUS RJTL TAHUN 2019 s.d April 2020

TREND UNIT COST RJTL TAHUN 2019 s.d April 2020

20 GROUPING RJTL TERTINGGI 2020
No Cbgs Biaya Kasus
1 M-3-16-0 - PROSEDUR THERAPI FISIK DAN PROSEDUR KECIL MUSKULOSKLETAL 38.373.600 354
2 N-3-15-0 - PROSEDUR DIALISIS 274.481.800 346
3 Q-5-42-0 - PENYAKIT AKUT KECIL LAIN-LAIN 41.836.100 227
4 Z-3-27-0 - PERAWATAN LUKA 39.904.000 215
5 Z-3-23-0 - PROSEDUR ULTRASOUND LAIN-LAIN 84.823.200 153
6 J-3-16-0 - PROSEDUR UJI FUNGSI PARU 64.547.700 147
7 U-3-16-0 - PROSEDUR PADA GIGI 29.499.200 103
8 J-3-13-0 - PROSEDUR TERAPI SALURAN PERNAFASAN 27.696.800 89
9 H-2-36-0 - PROSEDUR OPERASI KATARAK 510.445.200 73
10 K-5-18-0 - OTHER DIGESTIVE SYSTEM DISORDERS 15.635.200 64
11 Q-5-26-0 - BRONKIAL AKUT 10.098.400 52
12 Q-5-12-0 - GIGI 10.008.000 48
13 Z-3-25-0 - PROSEDUR ULTRASOUND GINEKOLOGIK 13.459.500 45
14 Q-5-43-0 - PENYAKIT KRONIS BESAR LAIN-LAIN 11.369.200 43
15 M-3-11-0 - PROSEDUR DIAGNOSTIK DAN TERAPEUTIK MUSKULOSKELETAL 15.526.800 38
16 G-5-17-0 - OTHER CRANIAL PERIPHERAL NERVE DISEASES 5.130.300 21
17 K-3-16-0 - PROSEDUR LAIN-LAIN PADA GASTROINTESTINAL 6.213.200 14
18 H-3-11-0 - PROSEDUR KECIL PADA EKTRAOKULER 3.579.800 14
19 L-3-12-0 - PROSEDUR KECIL PADA KULIT 2.272.600 11
20 Q-5-41-0 - PENYAKIT AKUT BESAR LAIN-LAIN 2.920.000 10

Diagnosa CBG M-3-16-0 - PROSEDUR THERAPI FISIK
DAN PROSEDUR KECIL MUSKULOSKLETAL s.d April 2020
No Diagnosa Utama Diag Sekunder Biaya Kasus

1 Z501 - Other physical therapy M543 - Sciatica Rp 9.105.600 84
2 Z501 - Other physical therapy M541 - Radiculopathy Rp 2.493.200 23
3 Z501 - Other physical therapy G510 - Bell's palsy Rp 2.384.800 22
4 Z501 - Other physical therapy I694 - Sequelae of stroke, not specified as haemorrhage or infarction Rp 2.276.400 21
5 Z501 - Other physical therapy G809 - Infantile cerebral palsy, unspecified Rp 2.059.600 19
6 Z501 - Other physical therapy G819 - Hemiplegia, unspecified Rp 1.951.200 18
7 Z501 - Other physical therapy M179 - narthrosis, unspecified Rp 1.951.200 18
8 Z501 - Other physical therapy M545 - Low back pain Rp 1.951.200 18
9 Z501 - Other physical therapy M174 - Other secondary narthrosis, bilateral Rp 1.734.400 16
10 Z501 - Other physical therapy F89 - Unspecified disorder of psychological development Rp 1.300.800 12
11 Z501 - Other physical therapy M705 - Other bursitis of knee Rp 1.192.400 11
12 Z501 - Other physical therapy S528 - Fracture of other parts of forearm Rp 975.600 9
13 Z501 - Other physical therapy G448 - Other specified headache syndromes Rp 867.200 8
14 Z501 - Other physical therapy S335 - Sprain and strain of lumbar spine Rp 758.800 7
15 Z501 - Other physical therapy I639 - Cerebral infarction, unspecified Rp 650.400 6
16 Z501 - Other physical therapy M543 - Sciatica; M179 - narthrosis, unspecified Rp 650.400 6
17 Z501 - Other physical therapy M750 - Adhesive capsulitis of shoulder Rp 650.400 6
18 Z501 - Other physical therapy G629 - Polyneuropathy, unspecified Rp 542.000 5
19 Z501 - Other physical therapy S822 - Fracture of shaft of tibia Rp 542.000 5
20 Z501 - Other physical therapy M478 - Other spondylosis Rp 433.600 4

Diagnosa CBG Q-5-42-0 - PENYAKIT AKUT KECIL
LAIN-LAIN s.d April 2020

1 H109 - Conjunctivitis, unspecified Rp 9.215.000 50
2 J069 - Acute upper respiratory infection, unspecified Rp 1.474.400 8
3 S335 - Sprain and strain of lumbar spine Rp 1.290.100 7
4 A010 - Typhoid fever Rp 1.105.800 6
5 L040 - Acute lymphadenitis of face, head and neck Rp 1.105.800 6
6 T159 - Foreign body on external eye, part unspecified Rp 1.105.800 6
7 R509 - Fever, unspecified Rp 921.500 5
8 G441 - Vascular headache, not elsewhere classified Rp 737.200 4
9 H000 - Hordeolum and other deep inflammation of eyelid Rp 737.200 4
10 H001 - Chalazion Rp 737.200 4
11 H109 - Conjunctivitis, unspecified H524 - Presbyopia Rp 737.200 4
12 H113 - Conjunctival haemorrhage Rp 737.200 4
13 H160 - Corneal ulcer Rp 737.200 4
14 H162 - Keratoconjunctivitis Rp 737.200 4
15 A099 - Gastroenteritis and colitis of unspecified origin Rp 552.900 3
16 B349 - Viral infection, unspecified Rp 552.900 3
17 G443 - Chronic post-traumatic headache Rp 552.900 3
18 H101 - Acute atopic conjunctivitis Rp 552.900 3
19 H332 - Serous retinal detachment Rp 552.900 3
20 R509 - Fever, unspecified J068 - Other acute upper respiratory infections of multiple sites Rp 552.900 3

Diagnosa CBG Z-3-27-0 - PERAWATAN LUKA s.d April
2020

1 Z098 - Follow-up examination after other treatment for other conditions Z961 - Presence of intraocular lens Rp 13.363.200 72
2 Z480 - Attention to surgical dressings and sutures O820 - Delivery by elective caesarean section Rp 6.310.400 34
3 Z480 - Attention to surgical dressings and sutures D485 - Neoplasm of uncertain or unknown behavior of skin Rp 2.412.800 13
4 Z480 - Attention to surgical dressings and sutures D487 - Neoplasm of uncertain or unknown behavior of other specified sites Rp 928.000 5
5 Z480 - Attention to surgical dressings and sutures K802 - Calculus of gallbladder without cholecystitis Rp 928.000 5
E115 - Non-insulin-dependent diabetes mellitus with peripheral circulatory
6 Z098 - Follow-up examination after other treatment for other conditions Rp 742.400 4
complications
D480 - Neoplasm of uncertain or unknown behavior of bone and articular
7 Z480 - Attention to surgical dressings and sutures Rp 742.400 4
cartilage
8 Z480 - Attention to surgical dressings and sutures D486 - Neoplasm of uncertain or unknown behavior of breast Rp 742.400 4
9 Z480 - Attention to surgical dressings and sutures K358 - Acute appendicitis, other and unspecified Rp 742.400 4
10 Z480 - Attention to surgical dressings and sutures K801 - Calculus of gallbladder with other cholecystitis Rp 556.800 3
11 Z480 - Attention to surgical dressings and sutures N40 - Hyperplasia of prostate Rp 556.800 3
12 A182 - Tuberculous peripheral lymphadenopathy Rp 371.200 2
13 C509 - Malignant neoplasm of breast, unspecified Rp 371.200 2
14 Z094 - Follow-up examination after treatment of fracture S528 - Fracture of other parts of forearm Rp 371.200 2
15 Z094 - Follow-up examination after treatment of fracture S822 - Fracture of shaft of tibia Rp 371.200 2
D439 - Neoplasm of uncertain or unknown behavior of central nervous
system, unspecified
D481 - Neoplasm of uncertain or unknown behavior of connective and other
soft tissue
complications
K052 - Acute periodontitis; E119 - Non-insulin-dependent diabetes mellitus
without complications
20 Rp 185.600 1
complications

Rujukan RJTL Tahun Pelayanan 2019 dan 2020
No Nm PPK Layan Poli Tuj SJP 2019 2020 Total
1 RS EKA HOSPITAL PEKANBARU HDL 350 112 462
2 RS EKA HOSPITAL PEKANBARU MAT 130 50 180
3 RSUD ARIFIN ACHMAD 17 141 36 177
4 RS IBNU SINA PEKANBARU HDL 117 52 169
5 RS AWAL BROS HDL 87 42 129
6 RS AWAL BROS A. YANI HDL 93 34 127
7 RSUD ARIFIN ACHMAD URO 111 15 126
8 RSUD ARIFIN ACHMAD JAN 87 39 126
9 RSUD ARIFIN ACHMAD INT 89 32 121
10 RSUD ARIFIN ACHMAD MAT 83 36 119
11 RS MATA SMEC MAT 97 19 116
12 RS AWAL BROS JAN 73 28 101
13 RSUD ARIFIN ACHMAD ORT 67 20 87
14 RS AWAL BROS SAR 75 9 84
16 RS Mata Pekanbaru Eye Center MAT 58 14 72
18 RS EKA HOSPITAL PEKANBARU INT 60 10 70
19 RSUD ARIFIN ACHMAD ANA 60 10 70
20 RSUD ARIFIN ACHMAD BDM 51 11 62

Diagnosa Utama Rujukan RJTL Tahun Pelayanan 2020 dari
RSUD Selasih
No Nm PPK Layan Diagnosa Utama Diag Sekunder 2020

1 RS EKA HOSPITAL PEKANBARU Z491 - Extracorporeal dialysis 112
2 RS IBNU SINA PEKANBARU Z492 - Other dialysis N185 - Chronic kidney disease, stage 5 56
3 RSUD ARIFIN ACHMAD Z491 - Extracorporeal dialysis N189 - Chronic renal failure, unspecified 48
4 RS AWAL BROS Z992 - Dependence on renal dialysis N185 - Chronic kidney disease, stage 5 42
5 RS SANSANI Z491 - Extracorporeal dialysis N189 - Chronic renal failure, unspecified 26
6 RS AWAL BROS A. YANI Z992 - Dependence on renal dialysis N185 - Chronic kidney disease, stage 5 21
7 RSUD ARIFIN ACHMAD Z511 - Chemotherapy session for neoplasm 16
Z089 - Follow-up examination after unspecified treatment for malignant
8 RSUD ARIFIN ACHMAD C509 - Malignant neoplasm of breast, unspecified 15
neoplasm
9 RS AWAL BROS Z955 - Presence of coronary angioplasty implant and graft I251 - Atherosclerotic heart disease 10
10 RS AWAL BROS A. YANI Z992 - Dependence on renal dialysis N189 - Chronic renal failure, unspecified 9
11 RS EKA HOSPITAL PEKANBARU Z098 - Follow-up examination after other treatment for other conditions I120 - Hypertensive renal disease with renal failure 9
Z099 - Follow-up examination after unspecified treatment for other
12 RSUD ARIFIN ACHMAD N189 - Chronic renal failure, unspecified 9
conditions
13 RS AWAL BROS Z501 - Other physical therapy I693 - Sequelae of cerebral infarction 8
14 RS EKA HOSPITAL PEKANBARU Z098 - Follow-up examination after other treatment for other conditions H599 - Postprocedural disorder of eye and adnexa, unspecified 8

15 RSUD ARIFIN ACHMAD E059 - Thyrotoxicosis, unspecified 8
conditions
16 RSUD ARIFIN ACHMAD M329 - Systemic lupus erythematosus, unspecified 8
conditions
17 RS AWAL BROS Z098 - Follow-up examination after other treatment for other conditions M545 - Low back pain 6
18 RS AWAL BROS A. YANI Z992 - Dependence on renal dialysis I120 - Hypertensive renal disease with renal failure 6
19 RS EKA HOSPITAL PEKANBARU Z098 - Follow-up examination after other treatment for other conditions H405 - Glaucoma secondary to other eye disorders 6
20 RSUD ARIFIN ACHMAD Z098 - Follow-up examination after other treatment for other conditions I120 - Hypertensive renal disease with renal failure 6

TREND KASUS, BIAYA DAN UNIT COST RITL s.d April 2020
BuPel Biaya Kasus Unit Cost

2019 1 908.258.400 218 4.166.323
2019 2 909.635.900 206 4.415.708
2019 3 757.678.200 192 3.946.241
2019 4 617.508.300 164 3.765.295
2019 5 723.682.300 184 3.933.056
2019 6 538.627.000 134 4.019.604
2019 7 864.268.600 223 3.875.644
2019 8 913.160.300 220 4.150.729
2019 9 716.338.500 185 3.872.100
2019 10 876.874.200 222 3.949.884
2019 11 980.142.500 245 4.000.582
2019 12 941.778.000 250 3.767.112
2020 1 793.645.200 214 3.708.622
2020 2 668.773.100 190 3.519.858
2020 3 666.803.100 185 3.604.341
2020 4 438.571.000 117 3.748.470
Rataan 760.221.983 197 3.845.834
TREND BIAYA RITL TAHUN Pelayanan 2019 s.d April 2020

TREND KASUS RITL TAHUN Pelayanan 2019 s.d April 2020

Tren Unit Cost RITL Tahun Pelkes 2019 s.d
April 2020

20 GROUPING RITL TERTINGGI 2020
No Cbgs Biaya Kasus

1 O-6-10-I - OPERASI PEMBEDAHAN CAESAR RINGAN 282.675.400 54
2 L-1-40-I - PROSEDUR PADA KULIT, JARINGAN BAWAH KULIT DAN PAYUDARA RINGAN 154.430.200 38
3 A-4-13-I - INFEKSI NON BAKTERI RINGAN 44.465.300 25
4 J-4-15-I - PERADANGAN DAN INFEKSI PERNAFASAN RINGAN 95.242.300 22
5 M-4-17-I - MASALAH BAGIAN PUNGGUNG/PINGGANG BELAKANG RINGAN 64.658.400 21
6 O-6-13-II - PERSALINAN VAGINAL SEDANG 38.374.000 20
7 O-6-13-I - PERSALINAN VAGINAL RINGAN 27.746.400 17
8 K-4-18-I - DIAGNOSIS SISTEM PENCERNAAN LAIN-LAIN (RINGAN) 21.314.500 16
9 J-4-17-II - PENYAKIT PARU OBSTRUKTIF KRONIS SEDANG 48.323.200 14
10 K-4-17-I - NYERI ABDOMEN & GASTROENTERITIS LAIN-LAIN (RINGAN) 16.175.600 10
11 I-4-12-I - KEGAGALAN JANTUNG RINGAN 27.547.300 9
12 G-4-15-I - KECEDERAAN PEMBULUH DARAH OTAK NON SPESIFIK & PENYUMBATAN PRE-CEREBRAL TANPA INFARK RINGAN 29.463.400 9
13 A-4-14-I - PENYAKIT INFEKSI BAKTERI DAN PARASIT LAIN-LAIN RINGAN 21.536.000 9
14 W-1-11-I - PROSEDUR DILATASI, KURET, INTRAUTERIN & SERVIK RINGAN 16.051.700 8
15 K-4-18-II - DIAGNOSIS SISTEM PENCERNAAN LAIN-LAIN (SEDANG) 16.391.600 8
16 J-4-17-I - PENYAKIT PARU OBSTRUKTIF KRONIS RINGAN 22.664.000 8
17 W-4-16-I - GANGGUAN ANTEPARTUM RINGAN 15.739.000 7
18 P-8-08-I - NEONATAL, BERAT BADAN LAHIR GROUP-5 DENGAN SINDROMA DISTRES PERNAFASAN RINGAN 28.683.100 7
19 N-4-10-II - TUMOR GINJAL & SALURAN URIN & GAGAL GINJAL SEDANG 23.424.800 7
20 K-1-14-I - PROSEDUR HERNIA INGUINAL DAN FEMORAL RINGAN 35.643.500 7

Diagnosa Terbanyak RITL Cbg K-4-17-I - NYERI
ABDOMEN & GASTROENTERITIS LAIN-LAIN (RINGAN)
s.d April 2020
No Diagnosa Utama Diag Sekunder Kasus
1 O342 - Maternal care due to uterine scar from previous surgery Z370 - Single live birth; O820 - Delivery by elective caesarean section 8
2 O342 - Maternal care due to uterine scar from previous surgery O820 - Delivery by elective caesarean section; Z370 - Single live birth 6
3 O322 - Maternal care for transverse and oblique lie O820 - Delivery by elective caesarean section; Z370 - Single live birth 4
4 O410 - Olihydramnios Z370 - Single live birth; O820 - Delivery by elective caesarean section 2
5 O619 - Failed induction of labour, unspecified Z370 - Single live birth; O820 - Delivery by elective caesarean section 2
6 O16 - Unspecified maternal hypertension Z370 - Single live birth; O820 - Delivery by elective caesarean section 1
O689 - Labour and delivery complicated by fetal stress, unspecified; O820 - Delivery by
7 O149 - Pre-eclampsia, unspecified 1
elective caesarean section; Z370 - Single live birth
8 O321 - Maternal care for breech presentation O820 - Delivery by elective caesarean section; Z370 - Single live birth 1
9 O321 - Maternal care for breech presentation Z370 - Single live birth; O820 - Delivery by elective caesarean section 1
O820 - Delivery by elective caesarean section; Z370 - Single live birth; O420 - Premature
10 O322 - Maternal care for transverse and oblique lie 1
rupture of membranes, onset of labour within 24 hours
Z370 - Single live birth; O689 - Labour and delivery complicated by fetal stress,
11 O322 - Maternal care for transverse and oblique lie 1
unspecified; O820 - Delivery by elective caesarean section
12 O322 - Maternal care for transverse and oblique lie Z370 - Single live birth; O820 - Delivery by elective caesarean section 1
Z370 - Single live birth; O429 - Premature rupture of membranes, unspecified; O820 -
13 O331 - Maternal care for disproportion due to generally contracted pelvis 1
Delivery by elective caesarean section
14 O331 - Maternal care for disproportion due to generally contracted pelvis Z370 - Single live birth; O820 - Delivery by elective caesarean section 1
Z370 - Single live birth; O820 - Delivery by elective caesarean section; O410 -
15 O332 - Maternal care for disproportion due to inlet contraction of pelvis 1
Olihydramnios
16 O339 - Maternal care for disproportion, unspecified Z370 - Single live birth; O820 - Delivery by elective caesarean section 1
O322 - Maternal care for transverse and oblique lie; Z370 - Single live birth; O820 -
17 O342 - Maternal care due to uterine scar from previous surgery Delivery by elective caesarean section; O689 - Labour and delivery complicated by fetal 1
stress, unspecified
O366 - Maternal care for excessive fetal growth; O820 - Delivery by elective caesarean
18 O342 - Maternal care due to uterine scar from previous surgery 1
section; Z370 - Single live birth
O410 - Olihydramnios; O820 - Delivery by elective caesarean section; Z370 - Single live
19 O342 - Maternal care due to uterine scar from previous surgery 1
birth
20 O342 - Maternal care due to uterine scar from previous surgery O842 - Multiple delivery, all by caesarean section; Z370 - Single live birth 1

Diagnosa Terbanyak RITL Cbg L-1-40-I - PROSEDUR PADA KULIT,
JARINGAN BAWAH KULIT DAN PAYUDARA RINGAN s.d April 2020

1 D485 - Neoplasm of uncertain or unknown behavior of skin 21
2 D486 - Neoplasm of uncertain or unknown behavior of breast 6
3 D487 - Neoplasm of uncertain or unknown behavior of other specified sites 4
4 D480 - Neoplasm of uncertain or unknown behavior of bone and articular cartilage 2
5 D180 - Haemangioma, any site 1
6 D370 - Neoplasm of uncertain or unknown behavior of lip, oral cavity and pharynx 1
7 D487 - Neoplasm of uncertain or unknown behavior of other specified sites D480 - Neoplasm of uncertain or unknown behavior of bone and articular cartilage 1
8 L929 - Granulomatous disorder of skin and subcutaneous tissue, unspecified I517 - Cardiomegaly 1
9 N601 - Diffuse cystic mastopathy 1

Diagnosa Terbanyak RITL Cbg A-4-13-I - INFEKSI NON BAKTERI
RINGAN s.d April 2020

1 A91 - Dengue haemorrhagic fever 10
2 A91 - Dengue haemorrhagic fever K30 - Dyspepsia 6
3 B349 - Viral infection, unspecified 3
4 A90 - Dengue fever [classical dengue] K30 - Dyspepsia 1
5 A91 - Dengue haemorrhagic fever A499 - Bacterial infection, unspecified 1
6 A91 - Dengue haemorrhagic fever I10 - Essential (primary) hypertension 1
7 A91 - Dengue haemorrhagic fever J069 - Acute upper respiratory infection, unspecified; K30 - Dyspepsia 1
8 B349 - Viral infection, unspecified J069 - Acute upper respiratory infection, unspecified 1
9 B349 - Viral infection, unspecified J209 - Acute bronchitis, unspecified 1

Segmen Peserta
2019 dan 2020

Kelas Rawat dan Sev
Level 2019 dan 2020

Cara Pulang 2019
dan 2020

LOS 2019 dan 2020

BOR 2019 dan 2020
Nama RS Kelas Hak Kasus Sum of Los TT19 Bor 19 Kasus Sum of Los TT 20 Bor 20
RSUD SELASIH Kelas II 648 2.042 16 35% 124 448 16 23%
RSUD SELASIH Kelas I 350 1.073 12 24% 85 259 12 18%
RSUD SELASIH Kelas III 1.405 4.484 78 16% 380 1.268 78 13%
1. Iur Biaya dan kenaikan kelas peserta apakah sudah sesuai

dengan Perpres 82 Tahun 2018
2. Jangan salah entry data tgl masuk, tgl keluar, dpjp dan cara
pulang
LOS 0 Hari 2019 dan
2020
No Nm Jns Pulang Diagnosa Utama Diag Sekunder 2019 2020 Total
1 Sehat O034 - Spontaneous abortion, incomplete, without complication 3 3
2 Sehat P034 - Fetus and newborn affected by caesarean delivery 2 2
3 Sehat O800 - Spontaneous vertex delivery Z370 - Single live birth 2 2
O420 - Premature rupture of membranes, onset of labour within
4 Sehat Z370 - Single live birth; O800 - Spontaneous vertex delivery 2 2
24 hours
K759 - Inflammatory liver disease, unspecified; O800 - Spontaneous vertex
5 Sehat O630 - Prolonged first stage (of labour) delivery; Z370 - Single live birth; O996 - Diseases of the digestive system 1 1
complicating pregnancy, childbirth and the puerperium
6 Sehat O429 - Premature rupture of membranes, unspecified Z370 - Single live birth; O800 - Spontaneous vertex delivery 1 1
7 Meninggal N185 - Chronic kidney disease, stage 5 M545 - Low back pain; M431 - Spondylolisthesis; R579 - Shock, unspecified 1 1
8 Meninggal K560 - Paralytic ileus I10 - Essential (primary) hypertension 1 1
J441 - Chronic obstructive pulmonary disease with acute
9 Meninggal D649 - Anaemia, unspecified; I279 - Pulmonary heart disease, unspecified 1 1
exacerbation, unspecified
A419 - Septicaemia, unspecified; E119 - Non-insulin-dependent diabetes
10 Meninggal J189 - Pneumonia, unspecified 1 1
mellitus without complications
I10 - Essential (primary) hypertension; R739 - Hyperglycaemia, unspecified; R55
11 Meninggal I64 - Stroke, not specified as haemorrhage or infarction 1 1
- Syncope and collapse
E780 - Pure hypercholesterolaemia; A162 - Tuberculosis of lung, without
mention of bacteriological or histological confirmation; R570 - Cardiogenic
12 Meninggal I500 - Congestive heart failure 1 1
shock; E790 - Hyperuricaemia without signs of inflammatory arthritis and
tophaceous disease
13 Meninggal G934 - Encephalopathy, unspecified E872 - Acidosis; N189 - Chronic renal failure, unspecified 1 1
E112 - Non-insulin-dependent diabetes mellitus with renal D638 - Anaemia in other chronic diseases classified elsewhere; N083 -
14 Meninggal 1 1
complications Glomerular disorders in diabetes mellitus
B209 - HIV disease resulting in unspecified infectious or parasitic disease; E876 -
15 Meninggal B207 - HIV disease resulting in multiple infections 1 1
Hypokalaemia
J441 - Chronic obstructive pulmonary disease with acute
16 Pulang Paksa B909 - Sequelae of respiratory and unspecified tuberculosis 1 1
exacerbation, unspecified
17 Pulang Paksa I64 - Stroke, not specified as haemorrhage or infarction 1 1
A162 - Tuberculosis of lung, without mention of bacteriological or histological
18 Pulang Paksa I279 - Pulmonary heart disease, unspecified 1 1
confirmation; B370 - Candidal stomatitis; K30 - Dyspepsia
19 Pulang Paksa I210 - Acute transmural myocardial infarction of anterior wall I120 - Hypertensive renal disease with renal failure 1 1
D649 - Anaemia, unspecified; D390 - Neoplasm of uncertain or unknown
20 Rujuk Z530 - Procedure not carried out because of contraindication 1 1
behavior of uterus

Verifikasi Paska Klaim 2020
No KETERANGAN
1 Pengkodingan gastritis dan peptic ulcer tanpa pemeriksaan endoskopi
2 Pengkodingan gastritis dan peptic ulcer tanpa pemeriksaan endoskopi
3 CT Scan dilakukan tidak sesuai prosedur
4 Satu episode perawatan dengan Rawat inap
Nm PPK Layan No SJP Diagnosa Utama Diag Sekunder

RSUD SELASIH 0409R0010919V002485 G819 - Hemiplegia, unspecified R470 - Dysphasia and aphasia; E789 - Disorder of lipoprotein metabolism, unspecified; I639 - Cerebral infarction,
RSUD SELASIH 0409R0011018V002627 G819 - Hemiplegia, unspecified E784 - Other hyperlipidaemia; I64 - Stroke, not specified as haemorrhage or infarction
Verifikasi Paska Klaim
2020
Diagnosa Utama Kode R dengan Diagnosa
Sekunder Spesifik
Nm PPK Layan (group) No SJP Diagnosa Utama Diag Sekunder
RSUD SELASIH 0409R0010320V001964 R560 - Febrile convulsions A090 - Other and unspecified gastroenteritis and colitis of infectious origin
RSUD SELASIH 0409R0011119V002398 R560 - Febrile convulsions A090 - Other and unspecified gastroenteritis and colitis of infectious origin
RSUD SELASIH 0409R0011118V000321 R560 - Febrile convulsions A099 - Gastroenteritis and colitis of unspecified origin
RSUD SELASIH 0409R0010320V001125 R55 - Syncope and collapse A91 - Dengue haemorrhagic fever
RSUD SELASIH 0409R0010719V003028 R104 - Other and unspecified abdominal pain D630 - Anaemia in neoplastic disease; K30 - Dyspepsia; C189 - Malignant neoplasm of colon, unspecifie
RSUD SELASIH 0409R0010119V003037 R572 - Septic shock E119 - Non-insulin-dependent diabetes mellitus without complications; E871 - Hypo-osmolality and hy
RSUD SELASIH 0409R0010219V001995 R560 - Febrile convulsions E46 - Unspecified protein-energy malnutrition
RSUD SELASIH 0409R0010719V003205 R572 - Septic shock E876 - Hypokalaemia; I500 - Congestive heart failure; J189 - Pneumonia, unspecified; R570 - Cardiogeni
RSUD SELASIH 0409R0010919V000116 R074 - Chest pain, unspecified I119 - Hypertensive heart disease without (congestive) heart failure
RSUD SELASIH 0409R0010320V001651 R560 - Febrile convulsions J00 - Acute nasopharyngitis [common cold]
RSUD SELASIH 0409R0010819V001420 R560 - Febrile convulsions J069 - Acute upper respiratory infection, unspecified
RSUD SELASIH 0409R0011119V000400 R560 - Febrile convulsions J069 - Acute upper respiratory infection, unspecified; E46 - Unspecified protein-energy malnutrition
RSUD SELASIH 0409R0010119V002940 R560 - Febrile convulsions J209 - Acute bronchitis, unspecified
RSUD SELASIH 0409R0010220V001986 R51 - Headache J329 - Chronic sinusitis, unspecified
RSUD SELASIH 0409R0010419V000240 R104 - Other and unspecified abdominal pain K30 - Dyspepsia
Verifikasi Paska Klaim
2020
Diagnosa Utama Kode Z dengan Diagnosa
Sekunder Spesifik
Nm PPK Layan No SJP Diagnosa Utama Diag Sekunder LOS

RSUD SELASIH 0409R0010120V000091 Z515 - Palliative care 2
K30 - Dyspepsia; R104 - Other and unspecified abdominal
RSUD SELASIH 0409R0010320V000358 Z038 - Observation for other suspected diseases and conditions pain; D379 - Neoplasm of uncertain or unknown behavior of 5
digestive organ, unspecified
RSUD SELASIH 0409R0010918V002561 Z038 - Observation for other suspected diseases and conditions K358 - Acute appendicitis, other and unspecified 3
G409 - Epilepsy, unspecified; R55 - Syncope and collapse; F89 -
RSUD SELASIH 0409R0011118V000587 Z038 - Observation for other suspected diseases and conditions Unspecified disorder of psychological development; K590 - 5
Constipation
RSUD SELASIH 0409R0011118V001360 Z515 - Palliative care 2
RSUD SELASIH 0409R0011218V001183 Z038 - Observation for other suspected diseases and conditions K358 - Acute appendicitis, other and unspecified 3
Komitmen Tahun 2020
No Indikator Evaluasi Komitmen

1 Memiliki sistem antrian online dan dashboard tindakan/prosedur yang terintegrasi dengan mobile
JKN
2 Display Ketersediaan TT dan Updating dashboard tempat tidur secara otomatis maksimal setiap 10
menit
3 Tertib administrasi klaim INA-CBGs dengan indikator sebagai berikut:
a) Penagihan klaim pending maksimal 2 kali,
b) Terdapat penurunan jumlah klaim pending per bulan;
c) Tidak terdapat klaim pending dengan kasus berulang setiap bulannya;
d) Tidak terdapat hasil verifikasi paska klaim dengan kasus yang sama.
4 Penurunan jumlah kasus dengan kunjungan > 2 kali untuk diagnosa penyakit kronis yang dapat
diberikan obat 7-23
5 Tercapainya rekrutmen PRB 100 % dari data potensi PRB
6 Melakukan perbaikan hasil rekredensialing
7 Tidak ada Iur Biaya Pelayanan, Pembatasan Kelas Perawatan,Menjamin Pelayanan Obat
8 Melaksanakan WTA dengan Poin > 85

Terima Kasih
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Dalam Genggaman!
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Review RSUD Selasih

Kantor Cabang Pekanbaru

Indikator : Target : Sumber Data :

Aplikasi SIPP, Lapor!, Care Center

Skor WTA > 85

Skor WTA > 85

April 20 Mei 20 Juni 20

RSUD SELASIH 292 - 3 295

Jenis Pelayanan Des-19 Jan-20 Feb-20 Mar-20 Apr-20 Mei-20 Jun-20

Sumber: SE33 bupem Juni 2020

JUMLAH BULAN ABSENSI KLAIM

3 Medis Konfirmasi indikasi rawat inap RITL 2 5 4 6 3

Sumber: bi tanggal 11 Juli 2020

Jan-20 Feb-20 Mar-20 Apr-20 Mei-20 Jun-20 Rataan 20

Sumber: ssbi tanggal 11 Juli 2020

Asal pintu masuk terbesar adalah Rujukan Internal dengan

No Nm Diag 2020 No Politujsep 2020

Sumber: ssbi tanggal 11 Juli 2020

Sumber: ssbi tanggal 11 Juli 2020

Sumber: ssbi tanggal 11 Juli 2020

Sumber: ssbi tanggal 11 Juli 2020

Sumber: ssbi tanggal 11 Juli 2020

Sumber: ssbi tanggal 11 Juli 2020

BuPel Biaya Kasus Unit Cost

Sumber: ssbi tanggal 11 Juli 2020

Sumber: ssbi tanggal 11 Juli 2020

Sumber: ssbi tanggal 11 Juli 2020

Sumber: ssbi tanggal 11 Juli 2020

No Diagnosa Utama Diag Sekunder Biaya Kasus

Sumber: ssbi tanggal 11 Juli 2020

No Diagnosa Utama Diag Sekunder Biaya Kasus

Sumber: ssbi tanggal 11 Juli 2020

No Diagnosa Utama Diag Sekunder Biaya Kasus

Sumber: ssbi tanggal 11 Juli 2020

Sumber: ssbi tanggal 11 Juli 2020

No Nm PPK Layan Diagnosa Utama Diag Sekunder 2020

Z099 - Follow-up examination after unspecified treatment for other

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BuPel Biaya Kasus Unit Cost

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No Cbgs Biaya Kasus

Sumber: ssbi tanggal 11 Juli 2020

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No Diagnosa Utama Diag Sekunder Kasus

Sumber: ssbi tanggal 11 Juli 2020

No Diagnosa Utama Diag Sekunder Kasus

Sumber: ssbi tanggal 11 Juli 2020

Sumber: ssbi tanggal 11 Juli 2020

Sumber: ssbi tanggal 11 Juli 2020

Sumber: ssbi tanggal 11 Juli 2020

Sumber: ssbi tanggal 11 Juli 2020

Sumber: ssbi tanggal 11 Juli 2020

1. Iur Biaya dan kenaikan kelas peserta apakah sudah sesuai

Sumber: ssbi tanggal 11 Juli 2020

Nm PPK Layan No SJP Diagnosa Utama Diag Sekunder

Nm PPK Layan No SJP Diagnosa Utama Diag Sekunder LOS

No Indikator Evaluasi Komitmen

6 Melakukan perbaikan hasil rekredensialing

8 Melaksanakan WTA dengan Poin > 85

Kini Semua Ada