DAMPAK IMPLEMENTASI TARIF INA-CBG’S TERHADAP KINERJA PENDAPATAN RUMAH SAKIT RK CHARITAS (CHARITAS HOSPITAL PALEMBANG)

Background: The Indonesia Casemix Based Groups (INA-CBG’s) system used by BPJS Health in the process of claim payments to provider hospitals is new and demands a change in the financial paradigm of private hospitals. Implementation of Fee For Services (FFS) is a reasonable system to be implemented because every diagnosis and action to patients is automatically recorded in the hospital billing system. Thus the hospital management easily compiled financial plans and cash flow. Charitas Hospital Palembang as a private hospital that is a provider with BPJS Health in Palembang has been providing services to BPJS patients since 2017. Method: This study is intended to clearly describe whether the government program in the field of National Health Insurance in this case the Social Security Administering Board ( BPJS) that uses the INA-CBG's tariff system provides positive solutions to hospitals. It is suspected that INA-CBG's rates cannot cover the cost of the service so that it will adversely affect the hospital. Discussion and Results: in 2018 provided 6,838 inpatient services. BPJS Health's contribution to Charitas Hospital Palembang amounted to 41,644,727,200.00 million rupiah. While the actual hospital billing was 64,378,390,385.00 million from inpatients. The loss of Charitas Hospital Palembang was allegedly due to the low INA-CBG rates that were 'claimed', which impacted management performance. analysis of the difference in the value of tariffs based on the diagnosis group between the BPJS Claim and the actual billing, the negative difference means that the Claim that the hospital is billed by the BPJS is smaller than the actual billing issued by the hospital. In conclusion, the BPJS Health Claim value is lower than the actual value of the hospital billing. Thus the alleged BPJS Health harm Charitas Hospital Palembang proven. Suggestion: Charitas Hospital Palembang management evaluates the unit cost calculation on each negative inpatient service unit. Keywords: actual billing, BPJS claims, INA-CBG rates