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All Journal Science Midwifery Cerdika: Jurnal Ilmiah Indonesia
Miliana, Elta
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Humanities Dentistry Economics, Econometrics & Finance Education Health Professions Nursing Public Health Social Sciences Veterinary

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Evaluation of supporting document completeness in outpatient claims to prevent BPJS claim returns at charitas Hospital Palembang Miliana, Elta; Pamungkas, Canggih Ajika
Science Midwifery Vol 13 No 1 (2025): April: Health Sciences and related fields
Publisher : Institute of Computer Science (IOCS)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35335/midwifery.v13i1.1900

Abstract

This study examined the completeness of outpatient claim documents and how it affected the return of claims by the national health insurance agency at Charitas Hospital Palembang. Incomplete documents often delay claim verification and lead to financial loss for healthcare providers. The research used a quantitative approach and analyzed 206 outpatient claim files submitted between February and June 2025. Data were collected through observation checklists and structured questionnaires distributed to administrative staff. The findings revealed that most returned claims were caused by missing laboratory or radiology results, incomplete referral documents, and inconsistent medical records. Statistical analysis showed a strong correlation between document completeness and the frequency of returned claims. Factors such as coordination between hospital units, staff competence, and the effectiveness of hospital information systems were found to significantly influence the completeness of claim files. The study concluded that improving internal communication, enhancing staff training, and optimizing electronic record systems can reduce the risk of claim rejection and improve financial sustainability.
Tinjauan Ketepatan Penggunaan Simbol dan Singkatan pada Ringkasan Pulang di Rumah Sakit Pusri Palembang Budiantono, Budiantono; Miliana, Elta; Sonia, Dina
Cerdika: Jurnal Ilmiah Indonesia Vol. 1 No. 12 (2021): Cerdika: Jurnal Ilmiah Indonesia
Publisher : Publikasi Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59141/cerdika.v1i12.256

Abstract

Latar Belakang: Simbol dan singkatan yang termasuk dalam standar SNARS Edition 1.1 terdapat di kelompok standar manajemen rumah sakit yaitu Manajemen Informasi Rekam Medis (MIRM 12). Tujuan: Tujuan penelitian yaitu mengidentifikasi ketepatan penggunaan simbol dan singkatan pada ringkasan pulang. Metode: Metode penelitian yaitu deskriptif restrospektif. Populasi dalam penelitian yaitu dokumen rekam medis rawat inap pada ringkasan pulang di Rumah Sakit Pusri Palembang  pada bulan Juni 2021. Besar sampel yaitu 153 berkas rekam medis pada ringkasan pulang dengan menggunakan rumus slovin. Instrumen penelitian menggunakan checklist dengan metode observasi dan dokumentasi. Hasil: Rumah Sakit Pusri Palembang sudah memiliki pedoman penulisan simbol dan singkatan namun dalam pelaksanaannya masih terdapat penggunaan simbol dan singkatan yang tidak tepat dan tidak ada didalam buku pedoman dan SPO simbol singkatan. Kesimpulan: Berdasarkan hasil observasi dan dokumentasi bahwa singkatan yang tidak tepat 11 %, tidak ada di buku pedoman 13 %, presentasi singkatan yang tepat 76%. Sedangkan simbol yang tidak ada didalam buku pedoman 58 %, presentasi simbol yang tepat 42%.
Co-Authors Budiantono, Budiantono Dina Sonia Pamungkas, Canggih Ajika