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Optimalisasi Manajemen Penanganan Klaim Pending Pasien Bpjs Rawat Inap di Rumah Sakit Citra Husada Jember Tahun 2018 Alfiansyah, Gamasiano; Nuraini, Novita; Wijayanti, Rossalina Adi; Putri, Fitriana; Deharja, Atma; Santi, Maya Weka
Kesmas Indonesia: Jurnal Ilmiah Kesehatan Masyarakat Vol 11 No 1 (2019): Jurnal Kesmas Indonesia
Publisher : Jurusan Kesehatan Masyarakat dan Fakultas Ilmu-Ilmu Kesehatan Universitas Jenderal Soedirman

Latar belakang: Perubahan paradigma pelayanan kesehatan harus disikapi oleh para pengelola rumah sakit. Peningkatan mutu dan patient safety menjadi faktor utama yang akan mempengaruhi peningkatan kinerja rumah sakit dalam era BPJS. Berdasarkan studi pendahuluan, ditemukan banyak formulir persyaratan klaim BPJS yang tidak lengkap dalam pengisiannya. Data menunjukkan masih ditemukan beberapa berkas klaim yang dikembalikan. Tujuan: melakukan optimalisasi manajemen dalam penanganan klaim pending melalui POAC. Metode: Penelitian ini merupakan penelitian kualitatif, dengan maksud menggali lebih dalam fungsi manajemen yang telah dilakukan. Penelitian dilakukan di Rumah Sakit Citra Husada Jember pada bulan Mei ? September 2018 dengan unit analisis adalah unit rekam medis di rumah sakit tersebut. Hasil: Proses penanganan claim pending berdasarkan aspek planning, organizing, actuating, dan controlling masih belum berjalan dengan baik. Hal tersebut diantaranya dikarenakan tidak adanya rincian pekerjaan dan job description, kurangnya motivasi dari pimpinan, dan tidak ada jadwal supervisi pimpinan yang jelas. Saran: Menyusun rencana kerja operasional dalam proses pengisian berkas persyaratan klaim BPJS, membuat susunan rincian pekerjaan dan job description dalam pengelolaan pengisian berkas persyaratan klaim BPJS rawat inap, menyusun SOP untuk memudahkan komunikasi antar petugas, dan menyusun jadwal supervisi pimpinan untuk mempermudah staf dalam melaporkan informasi yang harus dilaporkan. Kata kunci: Klaim Pending, BPJS, Manajemen

Impact of Work Environment and Work Stressing on The Job Satisfaction of Medical Record Officers Deharja, Atma; Rohman, Nonik Aisyah; Wijayanti, Rossalina Adi
JMMR (Jurnal Medicoeticolegal dan Manajemen Rumah Sakit) Vol 9, No 2 (2020): August
Publisher : Universitas Muhammadiyah Yogyakarta in Clollaboration with ADMMIRASI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.18196/jmmr.92123

Factors that influence the work satisfaction of medical record officer is the work environment and work stress. Uncomfortable work environment and work stressing with a lot of work demands make the staff will experience severe pressure. Based on the preliminary study on April 1st, 2018, it's found that seven officers who often absent (above 10%), small workspace, awkward movement, inadequate facilities, double jobs, and double shifts that made 10 out of 13 officers experience unenjoyable in their work. The purpose is to analyze the effect in the work environment and work stressing on the work satisfaction of medical record officers in the X Hospital. It is analytical with a cross-sectional approach using ordinal logistic regression and questionnaire as an instrument. The sample used is 13 medical record officersâ€”the work environment and work stressing as independent variables and work satisfaction as dependent variables. The significance value of the work environment and work stress variable is 0.002. It has a significance value Î± (P 0.05), proving that the work environment and work stressing have a significant effect on work satisfaction. This study's suggestions need to be the expansion of workspace, additional facilities, and officers to avoid double jobs and double shifts.

Relationship of Officersâ€™ Performance and Outpatientâ€™s Medical Record Time Provision Deharja, Atma; Irfiah, Irfiah; Wijayanti, Rossalina Adi; Ardianto, Efri Tri
JMMR (Jurnal Medicoeticolegal dan Manajemen Rumah Sakit) Vol 8, No 2 (2019): August
Publisher : Universitas Muhammadiyah Yogyakarta in Clollaboration with ADMMIRASI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.18196/jmmr.8296

The time for providing outpatient medical records according to the Indonesian Ministry of Health is â‰¤ 10 minutes. Based on the pre-survey at Hospital â€œXâ€ using 100 files of outpatient medical records showed that 80% the provision has been a delay. The aim of this study is to analyze the relationship of individuals, organizations, and psychology to the time of providing outpatient medical records. This is an analytic study with a cross-sectional method and the data analysis was carried out bivariate by chi-square test. Individual variables (ability) related to providingÂ aÂ time of outpatient medical records (Sig 0.08), sub-variable skill related to providing time outpatient medical records (Sig 0.061), organizational variables with job design sub-variables not related with providing time outpatient medical records (Sig 0.399). Sub leadership variables related with providing time outpatient medical records (Sig 0.08), psychological variables with attitude variables related with providing time outpatient medical records (Sig 0.015), sub motivation variables not related with providing time outpatient medical records (Sig 0.182). Related variables are individuals (abilities and skills), organizations with sub-leadership variables, psychological with sub attitude variables, meanwhile organizational variables with sub-job design variables, psychological variables with sub motivation variables are not related.

Impact of Work Environment and Work Stressing on The Job Satisfaction of Medical Record Officers Deharja, Atma; Rohman, Nonik Aisyah; Wijayanti, Rossalina Adi
JMMR (Jurnal Medicoeticolegal dan Manajemen Rumah Sakit) Vol 9, No 2 (2020): August
Publisher : Universitas Muhammadiyah Yogyakarta in Clollaboration with ADMMIRASI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.18196/jmmr.92123

Factors that influence the work satisfaction of medical record officer is the work environment and work stress. Uncomfortable work environment and work stressing with a lot of work demands make the staff will experience severe pressure. Based on the preliminary study on April 1st, 2018, it's found that seven officers who often absent (above 10%), small workspace, awkward movement, inadequate facilities, double jobs, and double shifts that made 10 out of 13 officers experience unenjoyable in their work. The purpose is to analyze the effect in the work environment and work stressing on the work satisfaction of medical record officers in the X Hospital. It is analytical with a cross-sectional approach using ordinal logistic regression and questionnaire as an instrument. The sample used is 13 medical record officersâ€”the work environment and work stressing as independent variables and work satisfaction as dependent variables. The significance value of the work environment and work stress variable is 0.002. It has a significance value Î± (P 0.05), proving that the work environment and work stressing have a significant effect on work satisfaction. This study's suggestions need to be the expansion of workspace, additional facilities, and officers to avoid double jobs and double shifts.

Factors Causing Delays in Submitting Inpatient BPJS Claims at RSU dr. H. Koesnadi Bondowoso Nuraini, Novita; Damayani, Desnia Sindi; Wijayanti, Rossalina Adi
Jurnal Aisyah : Jurnal Ilmu Kesehatan Vol 6, No 2: June 2021
Publisher : Universitas Aisyah Pringsewu

The submission of BPJS claims by health care facilities according to the technical verification manual is at least on the 10th of the following month. Meanwhile, in October 2019, the process of submitting inpatient BPJS claims at RSU dr. H. Koesnadi Bondowoso exceeded the 10th of the next month which was 130 days delayed. The purpose of this study analyzes the factors that cause the delays in submitting inpatient BPJS claims. The Type of qualitative research by finding out causal factors based on personal factors, leadership factors, team factors, system factors and contextual/situational factors using Problem Tree Analysis. Data collection techniques are in-depth interviews, observation, documentation and brainstorming. The results showed a lack of knowledge related to the deadline for submitting a BPJS claim and a delay in file submission from inpatient rooms. Incomplete files for inpatient BPJS, internal verifier have multiple jobs and lack of guidance from chief nurse also causes of delay in submitting claims. There are no standard operating procedures, hospital information management system and scanner error, an increase of workload, and less supportive of work environment due to the Covid-19 pandemic. It is recommended to make standard operating procedures for submitting inpatient BPJS claims, discipline the employees, give rewards and add more employees for the Controller Installation.Abstrak: Pengajuan klaim BPJS oleh fasilitas pelayanan kesehatan berdasarkan buku petunjuk teknis verifikasi maksimal tanggal 10 bulan berikutnya. Proses pengajuan klaim BPJS rawat inap di RSU dr. H. Koesnadi mengalami keterlambatan dimana pengajuan bulan Oktober 2019 melebihi tanggal 10 bulan berikutnya yaitu terlambat 130 hari. Tujuan penelitian ini menganalisis faktor yang menyebabkan keterlambatan pengajuan klaim BPJS rawat inap. Jenis Penelitian kualitatif dengan mencari faktor penyebab berdasarkan personal factors, leadership factors, team factors, system factors dan contextual/situational factors menggunakan Problem Tree Analysis. Teknik pengumpulan data dengan wawancara mendalam, observasi, dokumentasi dan brainstorming. Hasil penelitian menunjukkan penyebab keterlambatan pengajuan klaim BPJS rawat inap yaitu kurangnya pengetahuan batas tanggal pengajuan klaim BPJS rawat inap, keterlambatan setor berkas klaim BPJS rawat inap dari ruangan, ketidaklengkapan berkas klaim BPJS rawat inap, verifikator internal double job, kurangnya bimbingan Kepala Ruangan, kerja sama belum maksimal, belum adanya SOP, SIMRS dan scanner eror dan beban kerja bertambah serta lingkungan kerja kurang mendukung karena pandemic Covid-19. Solusi yang dapat dilakukan yaitu membuat SOP pengajuan klaim BPJS rawat inap, pendisiplinan petugas, pemberian reward dan menambah petugas di Instalasi Pengendali.

LITERATURE REVIEW: STAFF PERFORMANCE FACTORS RELATED TO INCOMPLETE MEDICAL RECORD DOCUMENTS IN PUBLIC HEALTH CENTER Wijayanti, Rossalina Adi; Lestari, Melia Sinta; Deharja, Atma; Santi, Maya Weka
Journal of Public Health Research and Community Health Development Vol. 7 No. 2 (2024): March
Publisher : Fakultas Ilmu Kesehatan, Kedokteran dan Ilmu Alam (FIKKIA), Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/jphrecode.v7i2.30241

Background: Patient medical records are records relating to the patient's identity, diagnosis, action, and to the treatment that has been given to the patient. Thus, medical records must be protected from damage, but damage to medical records is still found in every hospital. Purpose: This study attempts to investigate the causes of damage to hospital medical record materials. Methods: this is literature review, and the research was obtained from google scholar and the portal garuda, using full text articles. The measured results were factors that cause damage to medical record documents. Results: The main factor were still officers with a low level of education, namely high school graduates. This has an impact on filing officers to be not disciplined in maintaining medical record documents, and the absence of implementation of training related to management and storage management in the filing section. The machine factor was that there was no medical record rack available in accordance with the number of medical record documents. The method factor was that there was no SOP for maintaining medical records. The material factor was the raw material for the map using thin paper. The media factor, namely the storage space, has not been avoided from the dangers of water, fire, and biological damage. Conclusion: Based on 5M factors, the factors that have the highest influence on damage to medical record documents are the elements of people, machine, and material. While the factor that causes the least damage to medical record documents is the method.

STUDY OF LITERATURE RELATED TO STAFF PERFORMANCE FACTORS' LINKAGES TO INCOMPLETE MEDICAL RECORD DOCUMENTS IN PUBLIC HEALTH CENTER Wijayanti, Rossalina Adi; Zatin, Widian Almas; Nuraini, Novita
Journal of Public Health Research and Community Health Development Vol. 6 No. 2 (2023): March
Publisher : Fakultas Ilmu Kesehatan, Kedokteran dan Ilmu Alam (FIKKIA), Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/jphrecode.v6i2.31050

ABSTRACT Background: Excellent and quality medical record services can be seen from the contents of the completeness of the file, timely, accurate and compliance with aspects of legal requirements. The ideal standard for the completeness of medical record documents is 100%. However, based on a literature review, there are still medical record documents which weren't 100% complete. The incomplete filling of medical record documents is related to many things, including the delay in fulfilling the patient's rights to the contents of the medical record and reduction in the quality of medical record services. Purpose: The study aims to analyze the factors causing the incomplete filling of medical record documents at the public health center. Method: Data collection was conducted by literature search from the Google Scholar database and the Garuda Portal, and 12 articles were reviewed. Result: The biggest factor identified was the individual factors, namely the skills factor (75%), then knowledge factor (50%), and the lowest percentage was the ability factor (16.67%). On the organizational and motivator variables, the identified factors were leadership (50%) and motivator (16.67%). Conclusion: There was a need for documentation procedures in the form of Standard Operating Procedure that were socialized to health workers. There is also a need for leaders to provide communication forum between health personnels, and a form of evaluation and control in good and correct documentation of medical records combined with rewards and punishment system. It is also necessary to provide seminars and trainings to health workers regarding correct medical record filling. Health workers who have limited time to fill out, can arrange a good work plan.

The Optimization of Pharmacy Waiting Time Using the Lean Healthcare Method Nuraini, Novita; Wijayanti, Rossalina Adi
International Journal of Healthcare and Information Technology Vol. 1 No. 1 (2023): July
Publisher : P3M Politeknik Negeri Jember

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.25047/ijhitech.v1i1.3915

The waiting time for prescription services at dr. M. Suherman Clinic, a primary healthcare clinic with pharmacy services, did not meet the standard. It was about 15 minutes for the maximum waiting time for non-concoction prescriptions and 30 minutes for concoction medicines. A pre-liminary study of 100 patient visits in a day revealed that 15 non-concoction prescriptions and 20 concoction prescriptions exceeded the waiting times standard. It explicated the inefficiency in pharmacy services. The purpose of this research was to make the waiting time for pharmacies became more efficient. This research used lean healthcare method by using fishbone and 5M management elements. The data were collected by interviews, observation, and brainstorming. This study found that waiting time for pharmacy services approximately 36 minutes, with the Non-Value-Added ratio 56,7 %. It is concluded that the condition of pharmacy services had been inefficient. The units which contributed most waste were polyclinics and pharmacies. This research will produce a definite solution using the brainstorming method. The clinics need to standardize the deadline for doctors to input prescriptions, update the medical drug formulary, add new computers and drug blenders, add the number of staffs as human resources, and rearrange the clinic rooms.

BPJS Pending Claim Settlement Strategy In Hospital With Management Approach (Planning, Organizing, Actuating, Controlling) Wijayanti, Rossalina Adi; Dewi, Riskha Dora Candra; Farlinda, Sustin; Nuraini, Novita
International Journal of Healthcare and Information Technology Vol. 1 No. 1 (2023): July
Publisher : P3M Politeknik Negeri Jember

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.25047/ijhitech.v1i1.3917

The pending claim incident at Citra Husada Hospital Jember reached 33 files in December 2021, impacting health services' sustainability. This study aims to formulate a strategic policy review in the settlement of BPJS pending claims in hospitals with the Planning, Organizing, Actuating, and Controlling management approach. This research is qualitative. Data collection techniques using observation, interviews, documentation, and brainstorming. Test the validity of the data using source triangulation and technique triangulation. Based on the study results, the BPJS pending claim settlement strategy at Citra Husada Hospital Jember was implemented with a Planning, Organizing, Actuating, and Controlling management approach. Planning is carried out by preparing the quality of human resources and SOPs. Implementation of Organizing through coordination between officers and between fields, but there are still incomplete files and different interpretations between fields. Actuating is constrained by the system, while controlling is carried out through scheduled supervision.

Improvement Strategy to Reduce Delay in Returning Inpatient Medical Record at Jenggawah Primary Health Center in 2023 Nuraini, Novita; Febriyanti, Bella Amalia; Wijayanti, Rossalina Adi
International Journal of Health and Information System Vol. 2 No. 2 (2024): September
Publisher : Indonesian Journal Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47134/ijhis.v2i2.44

Delay return of inpatient medical records still occur at Jenggawah Primary Health Center with an average percentage 52,15%. This situation leads to misfiled records, potentially causing disruptions and errors in patient care. The purpose’s research was to develop a strategy to reduce delay return of inpatient medical records using action research. This research methodology is quasi-semi-experimental methodology, incorporating interviews, observations, documentation, and discussions for data collection. Results in diagnosing action, the delay in returning the medical record of inpatient was caused by the officers' lack of medical record knowledge and their lack of medical record training, the contents of the SOP, which required evaluation, and the tracer's inadequate work. Planning action to plan strategy which are hold medical record training, reviewing returning medical record’s SOP and redesigning tracer. Taking action to implement strategy during 3 month. There is the evaluation action, which includes 4 success parameters. Overall, it is considered successful if the percentage of delays in returning inpatient medical records is dropped to a maximum of 50% per month. Evaluating action to evaluate taking action were carried out properly because the percentage of delays in returning inpatient medical record was reduced below 50%. It’s hoped medical recorder always monev and remind each other regarding the return of inpatient medical records. And it’s hoped Jenggawah Primary Health Center will hold in house training, hold socialization of SOP and budgeting funds for supporting facilities.

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