Tips Praktis Mendisain Penatausahaan BLUD Rumah Sakit

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Sebenarnya istilah ‘penatausahaan’ bukan barang asing bagi rumah sakit.  Sebagai SKPD tentu saja ia terlibat dalam pengelolaan keuangan daerah.  Dan pemerintah daerah yang menaunginya pasti telah melengkapi dirinya dengan segepok regulasi yang menjamin bahwa setiap penerimaan dan pengeluaran kas yang dilakukan SKPD bawahannya telah dilakukan dengan benar, dengan jumlah dan sasaran penggunaan yang tepat.  Keyakinan ini hanya bisa diperoleh melalui serangkaian prosedur yang kerapkali disebut dengan ‘penatausahaan’.
Bagaimana dengan RS sebagai BLUD?  Permendagri 61/2007 sendiri telah mengatur tentang penatausahaan.  Lebih tepatnya ‘menyinggung’ bukan mengatur.  Karena sedikit sekali bahasan tentang penatausahaan yang dicakupnya.  Namun dari 3 pasal yang bicara penatausahaan, dapat disimpulkan bahwa Penatausahaan BLUD RS ditetapkan dalam rangka mewujudkan tertib administrasi dan tertib pelaksanaan serta pengendalian intern yang baik atas transaksi-transaksi keuangan maupun non keuangan rumah sakit.  Penatausahaan ditetapkan untuk memastikan bahwa setiap langkah-langkah kerja dilaksanakan sesuai dengan peraturan dan kebijakan yang berlaku dan  prinsip-prinsip bisnis yang sehat.

Penatausahaan BLUD RS yang baik tentu saja harus didasarkan pada dua kriteria utama di atas.  Pengendalian internal dan Ketaatan pada regulasi.  Pengendalian internal dibutuhkan agar setiap transaksi keuangan yang terjadi dapat diyakini telah dilakukan dengan benar dan aman.  Sedang ketaatan pada regulasi menjamin bahwa prosedur yang diterapkan tidak bertentangan dengan UU maupun peraturan pelaksana lainnya.

Disinilah kreativitas RS diuji.  Dengan SDM yang terbatas tapi harus mampu mengelola transaksi keuangan yang mampu mengamankan asetnya sekaligus mengamankan pelaksananya dari jeratan hukum regulasi.  Sedikitnya pasal tentang penatausahaan dalam Permendagri 61/2007 harus dipahami sebagai sebuah peluang bagi RS untuk membuat penatausahaan yang efisien sekaligus nyaman diimplementasikan oleh karyawannya.

Berikut adalah tips praktis untuk membuat model penatausahaan BLUD RS.

  1. Tentukan pihak yang terlibat dalam penatausahaan.
  2. Definisikan kewenangan para pihak.
  3. Rumuskan dokumen yang diperlukan.
  4. Buat bagan arus prosedur penatausahaan.
  5. Lengkapi dengan narasi prosedur.

Kok ringkas amat.  Tentu saja, kenapa harus rumit kalau bisa ringkas?  Begini neh penjelasannya.

1. Pihak yang terlibat.

Aduh serem amat, pake istilah pihak yang terlibat segala.  Maksudnya tuh, kita harus tahu orang-orang / bagian yang punya sangkut paut dengan aliran dokumen.  Perlakuan para pihak ketika menangani dokumen biasanya terklasifikasi dalam aktifitas seperti ini neh: penyusunan, pendistribusian, pengarsipan, atau otorisasi.  Maka tentukanlah orang-orang yang menyusun dokumen terkait, yang menerima distribusi, entah untuk pemenuhan kewajiban pelaporan atau untuk dimintakan tanda tangan, siapa juga yang harus mengarsip dan yang paling penting neh siapa orang yang berwenang mengotorisasi dokumen yang akan digunakan untuk mencairkan uang atau membuat perikatan dengan pihak ketiga.

Bila kita hendak membuat penatausahaan untuk penerimaan kas yang berasal dari penyelenggaraan layanan kesehatan untuk pasien umum, maka pihak yang terlibat boleh jadi adalah pasien, kasir, bendahara penerima, PPK dan akuntansi & verifikasi.  Bukan satpam, cleaning service dan penjaga kantin.

Kegagalan untuk mendefiniskan pihak yang terlibat akan berakibat penatausahaan yang kita bikin malah membingungkan.  Dan sudah pasti tidak efisien. So.., cobalah berlatih mengendus pihak yang terlibat untuk setiap prosedur penatausahaan yang hendak kita bikin.

2. Definisikan kewenangan para pihak.

Setelah para pihak kita definitifkan, maka diperlukan penguatan model kewenangan atau fungsi macam apa yang melekat pada masing-masing pihak.  Melanjutkan kasus di atas, fungsi pasien tentu saja membayar sejumlah uang atas layanan kesehatan yang diterimanya.  Tidak hanya sekedar menerima uang, pasien juga berhak menerima bukti pembayaran atas transaksi keuangan yang dilakukannya.  Kasir tentu saja menerima uang dari pasien, membuat kuitansi pembayaran, melakukan rekapitulasi penerimaan harian dan menyetorkannya ke bendahara penerima.  Begitu seterusnya untuk masing-masing pihak harus ada rasionalisasi fungsi kenapa dia diperlukan.

3. Rumuskan dokumen yang Diperlukan

Dokumen adalah catatan yang memberikan perlindungan penuh kepada masing-masing pihak.  Diperlukan karena ia sendiri adalah rekam jejak mengenai kualitas sebuah prosedur penatausahaan.  Bagi manajemen RS, dokumen adalah bentuk pertanggungjawaban kepada stakeholdernya bila dikemudian hari terjadi permasalahan baik hukum maupun manajemen.  Bagi pihak luar, dokumen adalah pernyataan legal mengenai seberapa kuat pengendalian internal atas prosedur penatausahaan yang diimplementasikan RS.  Berfungsi sebagai pijakan pengambilan kesimpulan atas kinerja manajemen mengelola RS.  Maka kejelian dan ketelitian mendefinisikan dokumen yang dibutuhkan pada hakikatnya adalah bentuk efisiensi dan konsistensi pengendalian internal itu sendiri.  Nah lho bingung kan?

Pada kasus di atas, maka dokumen yang diperlukan adalah kuitansi pembayaran pasien, rekapitulasi penerimaan harian kasir, tanda setoran kasir ke bendahara penerima dan tanda setor bendahara penerima ke kas BLUD.  Tentu saja akan membingungkan bila ditambah dengan dokumen riwayat pasien, Absensi kasir dan bendahara penerima, riwayat hidup ataupun riwayat kepangkatan.

4. Buat Bagan Arus Prosedur Penatausahaan.

Bagan arus melibatkan sejumlah lambang dan kode-kode yang sifatnya standar.  Banyak software di pasaran yang cukup powerfull dan sangat memudahkan kita membuat bagan arus.  Saya sarankan gunakan visio jangan excell ataupun word.  Bagaimanapun bagan arus adalah alat untuk mempermudah.  Bukan menambah kerutan kulit di kening kita.  Apa jadinya bila bagan arus yang kita buat malah membuat orang harus bekerja keras memahaminya?  Excell dan Word adalah aplikasi pengolah data dan kata, bukan untuk menggambar.

Perhatikan juga penempatan semua lambang dokumen dan proses.  Usahakan garis penghubung antar Lambang bagan tidak tumpang tindih.  Karena selain tidak sedap dipandang, juga menunjukkan bahwa pembuatnya sangat egois.  Membuat bagan arus yang hanya dirinya sendiri yang paham.

5. Lengkapi Dengan Narasi

Sebagus apapun bagan arus, ia hanyalah gambar yang tidak semua orang bisa memahaminya dengan cepat.  Perlu membumikan bagan tersebut dalam bentuk narasi sederhana.  Gunakan narasi untuk memberikan penjelasan-penjelasan sekedarnya yang tidak mampu diperankan oleh bagan.  Pastikan antara narasi dan bagan selaras dan saling mendukung.  Ketidakmampuan menarasikan bagan, bukan hanya membuat orang bertengkar kala mempersepsikannya namun juga membuat orang akan mengabaikannya dan membuat prosedur sendiri yang tidak tertulis.  Kalau itu yang terjadi, lantas buat apa kita repot-repot bikin narasi?

Tetap Semangat !

 

 

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