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All Journal Jurnal Kesehatan Komunitas Jurnal Ilmiah Ilmu Keperawatan Indonesia (Indonesian Nursing Scientific Journal) Majalah Ilmiah Warta Dharmawangsa Jurnal Ilmiah Perekam dan Informasi Kesehatan Imelda (JIPIKI) PRIMA : Portal Riset dan Inovasi Pengabdian Masyarakat Journal of Hospital Administration and Management (JHAM) Journal of Sustainable Community Service
Situmorang, Masriani
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Aerospace Engineering Humanities Automotive Engineering Biochemistry, Genetics & Molecular Biology Chemical Engineering, Chemistry & Bioengineering Decision Sciences, Operations Research & Management Economics, Econometrics & Finance Education Health Professions Industrial & Manufacturing Engineering Languange, Linguistic, Communication & Media Medicine & Pharmacology Nursing Public Health Social Sciences Veterinary

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Pelatihan dan Pendampingan Pengelolaan Berkas Klaim BPJS Kesehatan untuk Menurunkan Angka Pending Klaim Rawat Jalan di Rumah Sakit Umum X Mulyana, Mulyana; Situmorang, Masriani; Zhahara, Jihhan Naailah; Hasibuan, Rifdah Salsabila; Erika, Nur; Afrida, Aliya
PORTAL RISET DAN INOVASI PENGABDIAN MASYARAKAT Vol. 5 No. 2 (2026): MARCH
Publisher : Transpublika Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55047/prima.v5i2.2150

Abstract

BPJS Health claims are one of the main sources of funding for hospitals, which are highly dependent on the accuracy and completeness of claim files. A common problem is the high number of pending claims or claim files returned by BPJS Health due to administrative discrepancies, incorrect diagnosis and procedure coding, and incomplete supporting documents. This community service activity aims to improve the competence of casemix and medical record officers through training and mentoring in managing BPJS Health claims in order to reduce the number of pending outpatient claims at General Hospital X. The activity was carried out in stages: preparation, training and mentoring, and evaluation. The evaluation was conducted by measuring staff understanding through pre-tests and post-tests and comparing the percentage of pending claims before and after the community service activity. The results of the activity showed an increase in the average understanding score of officers from 62.5 to 86.3 and a decrease in the percentage of pending claims from 21.4% to 11.2% during the evaluation period. These findings indicate that training and mentoring in managing BPJS Kesehatan claims have a positive impact on partners and are recommended to be implemented continuously to maintain the quality of claim management in hospitals.
PERBANDINGAN ANGKA PENDING KLAIM RAWAT JALAN BPJS KESEHATAN BERDASARKAN LIMA KATEGORI PENYEBAB UTAMA: TINJAUAN DATA TIGA BULAN TERAKHIR Mulyana; Situmorang, Masriani; Bayazid, Nimas Esya; Cahyani, Hanifah; Farizha, Dinda
Journal of Hospital Administration and Management (JHAM) Vol 7 No 1 (2026): Journal of Hospital Administration and Management (JHAM)
Publisher : LPPM Universitas Awal Bros

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.54973/jham.v7i1.843

Abstract

Healthcare services through the National Health Insurance Program (JKN) require hospitals to manage the BPJS Kesehatan claims process accurately and timely, as delays or refunds can impact the continuity of hospital operations. One unit that plays a crucial role in this process is the Casemix Unit, which is responsible for grouping diagnoses and medical procedures and submitting claims based on BPJS Kesehatan regulations. This study aims to analyze the causes of the return of BPJS Kesehatan patient claim files for outpatient services at Awal Bros Gajah Mada Hospital. This study used a qualitative method with a descriptive approach, with Casemix Unit officers as the subjects and pending BPJS Kesehatan outpatient claim files as the objects. The results showed that of the 47,317 outpatient claim files from October–December 2024, 5,911 files (11.11%) were pending. The main causes of pending claims included incomplete required documents, inaccurate coding of diagnoses and medical procedures, problems with service episodes, and discrepancies between medical records and supporting examination results. The conclusion of this study indicates that completeness of files and accurate coding play a crucial role in the smooth processing of BPJS Kesehatan claims, necessitating increased coordination and accuracy in the outpatient claims management process.
Factors Causing Incomplete Medical Records of Covid-19 Patients in Santa Elisabeth Batam City Hospital 2021 Masriani Situmorang; Mulyana Mulyana; Abellya Abellya
Jurnal Ilmiah Ilmu Keperawatan Indonesia Vol 12 No 03 (2022): Jurnal Ilmiah Ilmu Keperawatan Indonesia (JIIKI) Volume 12 Number 03 September
Publisher : UIMA Press

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (263.78 KB) | DOI: 10.33221/jiiki.v12i03.1511

Abstract

Background: One of the active roles of medical recorders is to determine the quality of health services in hospitals with good and complete data or information from medical records. Outpatient medical record services start from the place of registration until obtaining medical record documents used to obtain health services. Objectives: Objective To find out the factors that cause incomplete filling of medical record files, especially for Covid-19 patients at Santa Elisabeth Hospital in 2021. Methods: Methods The type of research used in this research is research qualitative with a qualitative approach and using the interview method, observation, and questionnaire. Results: The results of the study show that the large workload and time constraints are the main factors for nurses and doctors not filling out completely, and the part of the medical record that is not filled in greatly affects the claim of BPJS or the Ministry of Health. Conclusion: The incompleteness of the medical record form for Covid-19 patients still has obstacles in the element of lack of communication between health care workers, and discipline of officers due to lack of awareness of doctors about the importance of completing medical record files. The workload is quite high, motivation is low, there is no mix, policy, and SOP in the medical record section, lack of socialization about medical record SOP.
Emotional Intelligence is Related to Adolescent Knowledge About the Dangers of Pregnancy at a Young Age Eka Fitri Amir; Murniati Safitri; Masriani Situmorang
Jurnal Ilmiah Ilmu Keperawatan Indonesia Vol 11 No 01 (2021): Jurnal Ilmiah Ilmu Keperawatan Indonesia, Volume 11 No. 01 Year 2021 : Surgery
Publisher : UIMA Press

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (357.882 KB) | DOI: 10.33221/jiiki.v11i01.2097

Abstract

Background: Adolescent knowledge is influenced by internal factors and external factors, Internal factors consist of physical factors and psychological factors. IntellectualIncome (IQ) only accounts for 20% of success and 80% due to other factors. Intelligence plays a very important role in a person's success, one of which is emotional Qoutient (EQ). The results of the interview with 10 responders with the results of 5 people among them could not restrain their emotions and were unable to accept the input of others. If adolescents have a correct and accurate understanding of sexual reproductive health information, the adolescents tend to have a lower risk. Objectives: This study aims to determine the relationship between Emotional Intelligence and adolescent knowledge about the dangers of pregnancy at a young age. Methods: A correlational descriptive type of research with a cross-sectional approach. sampling using random sampling and obtained a total sample of 72 respondents. Data analysis using Kendall Tau. Most of the respondents had moderate emotional intelligence of 48 people (68.6%), and most of the respondents had knowledge in the Good category of 41 people (58.6%). Results: Based on a statistical analysis test using Kendall Tau between emotional intelligence and adolescent knowledge about the dangers of pregnancy at a young age, a value of (Ï„) of 0.508 was obtained. Conclusion: Then it can be concluded There is a significant relationship between emotional intelligence and with adolescent knowledge of the dangers of pregnancy at a young age.
Co-Authors Abellya Abellya Afrida, Aliya Bayazid, Nimas Esya Cahyani, Hanifah Claudyana, Inka Desla DELIA ALTESA PUTRI Dr.Mulyana, SKM., M.Kes Eka Fitri Amir Erika, Nur ERWINDA, TASYA AULIA Farizha, Dinda Hasibuan, Rifdah Salsabila Marian Tonis Mirawati, Dian Monadia, Monadia Mulyana Mulyana Mulyana Mulyana Mulyana Murniati Safitri Natasha, Natasha Rahmawati Salsabila, Salsabila Sherly Mutiara siti wulandari SULIS OKTA ANGGERAINI Zhahara, Jihhan Naailah