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All Journal Abdi Dosen : Jurnal Pengabdian Pada Masyarakat PELS (Procedia of Engineering and Life Science) Promotor: Jurnal Mahasiswa Kesehatan Masyarakat
- Yastori, -
Laboratorium Ekologi Tumbuhan, Jurusan Biologi, FMIPA Universitas Andalas, Limau Manis Padang -25163
Religion Humanities Computer Science & IT Control & Systems Engineering Education Electrical & Electronics Engineering Engineering Nursing Public Health Social Sciences Other

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Case Analysis of Compensation Audit by BPJS in Hospital X Year 2023 Yastori, Yastori; Khumaira, Nurul Fitri; Oashttamadea, Ressa
PROMOTOR Vol. 7 No. 5 (2024): OKTOBER
Publisher : Universitas Ibn Khaldun Bogor

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32832/pro.v7i5.933

Abstract

Audit Compensation Audits cause operational activities and hospital financial systems to become disrupted and unstable. Based on a preliminary survey at the Hospital, this research aims to analyze Compensation Audit cases carried out by health insurance providers in 2023. The type of research used is Mixed Method, namely a research approach that combines or links qualitative and quantitative forms. This research was conducted in January – June 2024. The research population was 5 compensation audit cases in 2023. In-depth analysis was carried out on 5 compensation audit cases based on analysis of medical resumes, related regulations and based on ICD-10 and ICD-9-CM coding rules. Compensation Audit Case Solution, namely coders must understand medical records, claim submission documents, ICD-10, ICD-9 CM coding rules, BPJS and hospital PPK claims regulations, doctors need to provide clear, specific management and be able to know the patient's condition. treatment class from the start of admission and the health insurance verifier must have the same perception as the previous verifier and be careful in reading and analyzing claim submission documents.
OPTIMIZING MEDICAL TERMINOLOGY INTERPRETATION AND ICD-10 CODING SKILLS FOR SURGICAL CASES AT RSKB ROPANASURI PADANG Khumaira, Nurul Fitri; Yastori, Yastori; Kader, Shaola Syafrullah; Novita, Dian
Abdi Dosen : Jurnal Pengabdian Pada Masyarakat Vol. 9 No. 3 (2025): SEPTEMBER
Publisher : LPPM Univ. Ibn Khaldun Bogor

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32832/abdidos.v9i3.2912

Abstract

This community service activity focused on improving the understanding of medical terminology and ICD-10 coding accuracy for surgical cases at RSKB Ropanasuri Padang. The main problem identified was the difficulty medical record officers faced in correctly interpreting medical terminology used by doctors, especially in surgical diagnoses. This often led to inaccurate coding, impacting the hospital's data and finances. The solution provided was a comprehensive training session, which included socialization, case studies, and discussions to enhance participants' understanding of medical terminology and improve their ICD-10 coding skills. The results showed significant improvement in participants' ability to interpret diagnoses and apply the correct ICD-10 codes, with pretest scores increasing by 71.43% after the training. This study emphasizes the importance of standardized medical terminology and continuous training for improving diagnostic coding accuracy in healthcare settings. Further training on diverse medical cases is recommended to enhance coding proficiency.
SOCIALIZATION OF FACTORS CAUSING PENDING CLAIMS AT RSI. IBNU SINA 'YARSI' PADANG Yastori, Yastori
Abdi Dosen : Jurnal Pengabdian Pada Masyarakat Vol. 7 No. 1 (2023): MARET
Publisher : LPPM Univ. Ibn Khaldun Bogor

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32832/abdidos.v7i1.1589

Abstract

Coding accuracy is closely related to claims or financial hospital financing. The claim made by the health insurance is the submission of the cost of treating the patient's health insurance participant by the hospital to the health insurance party which is carried out collectively and billed to the health insurance funder every month. Based on a preliminary study on the incidence of pending claims at RSI. Ibnu Sina 'Yarsi' Padang occurred due to inaccuracies in giving the code or incompleteness, incompatibility of supporting document files, or evidence that was in line with the diagnosis written on the medical record documentation. This Community Service Activity (PKM) has been carried out on October 17, 2022, at RSI. Ibnu Sina 'Yarsi' Padang which was attended by 19 participants to provide understanding and knowledge related to examples of factors that affect pending claims cases. The method of implementation is in the form of socialization and delivery of case examples as well as discussion of the discussed cases, then a session of filling in the link of questions related to the material is carried out as well as interviews and direct discussions with medical record officers and participants present during the discussion session. The activity went smoothly, it could be seen that the participants began to understand and were able to analyze the influencing factors and coding rules related to the pending claim case at the RSI Ibnu Sina 'Yarsi' Padang.
Compensation Audit Case at Casemix Hospital X Yastori, Yastori; Putri, Riza Suci Ernaman; Khumaira, Nurul Fitri; Oktavia, Dewi
Procedia of Engineering and Life Science Vol. 6 (2024): The 3rd International Scientific Meeting on Health Information Management (3rd ISMoHI
Publisher : Universitas Muhammadiyah Sidoarjo

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21070/pels.v6i0.1966

Abstract

Audit Compensation Audits result in operational activities and hospital financial systems becoming disrupted and unstable. Based on a preliminary survey at Hospital This research aims to analyze Compensation Audit cases carried out by health insurance providers in 2023. The type of research used is using the Mixed Method, a research approach that combines or associates qualitative and quantitative forms. This research was conducted in March - June 2024. The research population was 11 compensation audit cases in 2023. Total sampling technique. An in-depth analysis was carried out on 11 compensation audit cases based on analysis of medical resumes, related regulations and based on ICD-10 and ICD-9-CM coding rules. The results of research that carried out an in-depth analysis of compensation audit cases showed that most compensation audit cases were caused by the enforcement of treatment classes with a total of 3 cases, specific management 2 cases, combination code 1, availability of death reports 1, regulations for enforcing the main diagnosis 1, specific management for main diagnosis 1, unavailability of anatomical pathology attachments 1, errors in establishing the main diagnosis and non-compliance with medical procedures and supporting documents 1. Compensation Audit Case Solution, namely the coder must understand medical records, claim submission documents, ICD-10, ICD-9-coding rules CM, health insurance provider and hospital PPK claim regulations, doctors need to provide clear, specific management and be able to determine the patient's condition. treatment class from the start of entry and the health insurance verifier must have the same perception as the previous verifier and be careful in reading and analyzing the claim submission documents.
Co-Authors Dian Novita Kader, Shaola Syafrullah Khumaira, Nurul Fitri Oashttamadea, Ressa Oktavia, Dewi Putri, Riza Suci Ernaman