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All Journal Jurnal Rekam Medik & Manajemen Informasi Kesehatan (RAMMIK) Proceeding of International Conference Health, Science And Technology (ICOHETECH)
Zaenal Abidin, Arif
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Computer Science & IT Decision Sciences, Operations Research & Management Dentistry Health Professions Industrial & Manufacturing Engineering Medicine & Pharmacology Public Health Veterinary

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Gambaran Penyebab Pending Claim BPJS Kesehatan Akibat Ketidaktepatan Kode Diagnosis di Rumah Sakit Universitas Sebelas Maret (UNS) Cindy Rozza Bella; Pratama, Aldi; Zaenal Abidin, Arif
Jurnal Rekam Medik & Manajemen Informasi Kesehatan Vol. 3 No. 2 (2024): Oktober
Publisher : Indonesian Journal Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47134/rmik.v3i2.47

Abstract

In the process of submitting a BPJS Health claim, not all files submitted can be claimed. Claim status is declared ineligible or pending. A pending claim occurs if the claim file submitted by the hospital is incomplete or does not comply with the requirements set by BPJS Health. Delayed claims can disrupt hospital cash flow and cause losses for the hospital and BPJS Health participants. This research aims to describe the causes of pending claims at UNS Hospital. This research is a quantitative descriptive study with a population of 182 inpatients pending claim files at UNS Hospital for the period August-October 2023. The sample for this research is 78 pending claim files based on diagnosis code verification. The sampling technique is total sampling. Based on the data obtained, the number of files with coding confirmation is 78 pending claim files or 11.3% of the total pending claims in the period August – October 2023. This data shows that the majority of pending claim files are due to inaccurate diagnosis. The factor causing pending claims from BPJS Health inpatients at UNS Hospital occurs due to differences in perception between hospital staff and BPJS Health and is not purely due to coder error, but due to a lack of supporting data as a diagnosis enforcer which affects the accuracy of the code.
OVERVIEW OF THE MEDICAL RECORDS DEPARTMENT STAFF REQUIREMENT BASED ON HEALTHCARE WORKLOAD ANALYSIS METHOD AT UNIVERSITAS SEBELAS MARET HOSPITAL SUKOHARJO IN 2023 Cahyaningrum, Nopita; Ika Wulandari, Fitria; Zaenal Abidin, Arif; Nur Afitri, Agita
Proceeding of the International Conference Health, Science And Technology (ICOHETECH) 2023: Proceeding of the 4th International Conference Health, Science And Technology (ICOHETECH)
Publisher : LPPM Universitas Duta Bangsa Surakarta

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47701/icohetech.v4i1.3394

Abstract

Universitas Sebelas Maret (UNS) Hospital currently employs 30 staff members in medical records department. The number of the staff exceeds the required workload. The objective of this research is to find out the requirement of medical records staff based on healthcare workload analysis method in UNS Hospital Sukoharjo. This research is a descriptive survey by implementing cross sectional approach. The samples taken are saturated samples. They are 30 staff members in medical records department. Data were collected through interviews and observations. The calculation of the requirement of medical records staff by implementing healthcare workload analysis method shows that 32 employees required in this department: 1 employee as a Head of Medical Records Deparment, 1 employee as a Registration Coordinator, 13 staff in Outpatient Services and Registration of Executive Patients and Online Patient, 4 employees in Emergency and Inpatient Services, 3 employees in Inpatient Assembly, and 4 employees in Outpatient Assembly and Inpatient/Outpatient Coding, and 6 employees in Medical Records Filing. In fact, there are currently 30 employees work in Medical Records Department of UNS Hospital, Sukoharjo. The result of healthcare workload analysis shows that this hospital needs 32 employees in this department. Therefore, it is suggested that the hospital should hire 2 more employees as staff members in Medical Records Department in order to effectively match the workload.
Co-Authors Cindy Rozza Bella Ika Wulandari, Fitria Nopita Cahyaningrum Nur Afitri, Agita Pratama, Aldi