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All Journal Cermin Dunia Kedokteran Jurnal ARSI : Administrasi Rumah Sakit Indonesia
Kusumawati, Ayu Nadya
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Decision Sciences, Operations Research & Management Health Professions Medicine & Pharmacology Public Health Social Sciences

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Faktor – faktor Penyebab Pending Klaim Rawat Inap di RSUD Koja Tahun 2018 Kusumawati, Ayu Nadya; -, Pujiyanto
Cermin Dunia Kedokteran Vol 47, No 1 (2020): Bedah
Publisher : PT. Kalbe Farma Tbk.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (721.779 KB) | DOI: 10.55175/cdk.v47i1.338

Abstract

Pada tahun 2014, Indonesia mulai menerapkan Sistem Jaminan Kesehatan Nasional berdasarkan Undang-undang nomor 40 tahun 2004 tentang Sistem Jaminan Sosial Nasional. Rumah sakit terus berupaya untuk mempercepat proses klaim agar alur cash flow tidak terganggu, oleh karena itu perlu diidentifikasi faktor penyebab pending klaim agar dapat dianalisis dan diperbaiki. Penelitian dilaksanakan di RSUD Koja dari bulan Juni hingga Juli 2019 dengan mengambil data pending klaim selama tahun 2018, terbatas pada pending klaim rawat inap dan yang terkait dengan masalah medis dan resume medis. Selain itu dilakukan wawancara mendalam kepada satu orang verifikator, satu orang koder dan satu orang grouper. Didapatkan 40,6% berkas merupakan kesalahan koding dan input, 21,9% kesalahan penempatan diagnosis dan 37,4% ketidaklengkapan resume medis. Dibutuhkan pembaharuan ilmu aturan dan kaidah koding terbaru serta penerapan rekam medis elektronik untuk mempermudah DPJP dalam melengkapi resume medis. In 2014, Indonesia began to implement National Health Insurance System based on Law Number 40, 2004. As hospitals continue to strive to speed up claim process to manage the cash flow, it is necessary to identify the causes of claim pending. The study was conducted at Koja District Hospital from June to July 2019 by taking pending claims data during 2018 and limited to inpatient pending claims related to medical problems and medical resumes. In-depth interviews were conducted with one verifier, one coder and one grouper. Causes of pending were coding and input errors (40.6%), misplaced diagnoses (21.9%) and incomplete medical resumes (37.4%). Knowledge updates on latest coding rules for coders and the application of electronic medical records to facilitate DPJP in completing medical resumes are needed. 
Analisis Kinerja Dokter Verifikator Internal dalam Menurunkan Angka Klaim Pending di RSUD Koja Tahun 2018 Kusumawati, Ayu Nadya; Pujianto, Pujianto
Jurnal ARSI : Administrasi Rumah Sakit Indonesia Vol. 6, No. 1
Publisher : UI Scholars Hub

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Abstract

The doctor's internal verifier has an important task in reducing the number of pending claims especially for controlling the suitability of coding with diagnoses on medical resumes. This research explain that the performance of internal verifier doctors in reducing the number of pending claims in Koja Hospital in 2018 by reviewing claims files and observations on claim data from 2017 to 2019. This study uses an intervention evaluation study design by analyzing quantitative and qualitative data. The method used is to compare data coding errors on pending hospitalization claims Pre-intervention and Post-Intervention doctor internal verifiers both in number of claims and nominal claims. Then conduct in-depth interviews to find out the cause of coding errors to cause pending claims. The results of this study are that the proven internal verifier can reduce the number of pending hospitalization claims due to coding errors and obtained the causes of coding errors, namely incomplete medical resumes, lack of coder accuracy, lack of coder knowledge, lack of uniformity of information related to claim file coding and overload not accompanied by suitability of the number of coders. This can be minimized by the use of electronic medical records, training of coder personnel, team building and the addition of coder personnel.
Identifikasi Faktor–Faktor yang Berpengaruh Terhadap Medical Tourism pada Rumah Sakit di Indonesia Kusumawati, Ayu Nadya
Jurnal ARSI : Administrasi Rumah Sakit Indonesia Vol. 5, No. 1
Publisher : UI Scholars Hub

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Abstract

Medical tourism is an activity carried out by an individual to get a health service or medical care abroad. In the effort to develop the health system and competition and the impact of health globalization, it does not rule out the possibility that medical tourism raises intense competition among hospitals in providing quality services and superior service products provided by hospitals in attracting foreign patients to come get treatment. Objective of this research is to determined factors that affect hospital to be medical tourism’s aim. Methods in this research is literature review from international journals. The results is hospital needs to improve their physician’s skill, facilities, accessibility, and promotions. So that medical tourism is a new phenomenon for hospitals in Indonesia to prepare professional and superior health personnel and sophisticated health technology as a developmental need for medical tourism. Need to study or identify factors that influence medical tourism in hospitals in Indonesia.
Co-Authors Pujianto Pujianto Pujiyanto -