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All Journal Jurnal Kesehatan Indonesia Open Access Indonesian Journal of Medical Reviews Jurnal Ilmiah Kesehatan Masyarakat Student Scientific Creativity Journal Jurnal Medika Nusantara Vitamin: Jurnal Ilmu Kesehatan Umum Jurnal Ilmu Kedokteran dan Kesehatan Indonesia
Deasy Rosmala Dewi
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Arts Decision Sciences, Operations Research & Management Dentistry Economics, Econometrics & Finance Education Health Professions Languange, Linguistic, Communication & Media Medicine & Pharmacology Nursing Public Health Social Sciences Veterinary

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Journal : Vitamin: Jurnal Ilmu Kesehatan Umum

 1 
Tinjauan Penyebab Klaim Pending Pasien Badan Penyelenggara Jaminan Sosial (BPJS) Rawat Inap di RSUD Kembangan Jakarta Barat Iman Harapan Jaya Zalukhu; Deasy Rosmala Dewi; Daniel Happy Putra
Vitamin : Jurnal ilmu Kesehatan Umum Vol. 2 No. 3 (2024): July : Jurnal ilmu Kesehatan Umum
Publisher : Asosiasi Riset Ilmu Kesehatan Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.61132/vitamin.v2i3.437

Abstract

Financing activities at Kembangan Regional Hospital are dominated by BPJS Health Participants, when submitting claim from patients participating in BPJS Health, there are still delays in submitting claim which will have an impact on hospital operational activities. The aim of this research was to determine the causes of Pending Claims that accurred at Kembangan Regional Hospital. This study used a descriptive method with a mix method approach. The BPJS Health claim procedure for inpatient services at Kembangan Hospital is in accordance with the exiting Standar Operating Procedures. The data used are pending claim files originating from inpatient treatment in November 2022- Jaunary 2023. The research result found 941 inpatient claim files and 84 pending claim files. The cause of pending claim were classified into 7, Conformity between surgical procedures was 22 (26%), inaccuracy in administrative verification and SEP suitability in inputting data into INA-CBGs was 19 (23%), coding determined by the coder was not unbundled by 17 (20%), INA-CBG codes was 9 (!1%), DPJP daognostic code matching 6 (7%), Hospital code conformity 6 (7%), and finally redmissions for the same disease coding 5 (6%). Based on the 5M identification, there are factors, namely the man factor: because the claim file was not accepted by BPJS Health due to coding. The coding given by the hospital to the hospital to the BPJS was not appropriate. Material: supporting files which arrived late on the specified day. Meanwhille, the 3 other factors, namely the money machine and methid, were not obstacles or causes fot the return of the claim files. It is recommended to reevaluate and socialize the reasoms fpr returning BPJS Health claims so that the BPJS Health claim submission process is carried out well and accepted.
Tinjauan Ketepatan Penjajaran Rekam Medis Di Rumah Sakit Umum Daerah Kembangan Fauziah Irfany; Lily Widjaja; Laela Indawati; Deasy Rosmala Dewi
Vitamin : Jurnal ilmu Kesehatan Umum Vol. 2 No. 1 (2024): January : Jurnal ilmu Kesehatan Umum
Publisher : Asosiasi Riset Ilmu Kesehatan Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.61132/vitamin.v2i1.188

Abstract

Alignment is the process of aligning medical records in the storage room according to the system used. The medical record storage system at Kembangan Hospital uses centralization, the medical record numbering system uses the Unit Numbering System (UNS) and the alignment system uses Terminal Digit Filing (TDF). The aim of this research is to determine the accuracy of medical record alignment. This research used a descriptive method with a quantitative approach, the population was 293 medical records using a saturated sample. From the results of research on the primary digit 07 storage shelf, it was found that there were inaccuracies in the alignment of 162 medical records (55%). This alignment inaccuracy was divided into three digits, namely 34 medical records (21%) had the 1st digit incorrect, 85 medical records (52%) had the 2nd digit incorrect and 43 medical records (27%) had the 3rd digit incorrect. . It was found that the cause of the alignment error was due to human error, the unavailability of a tracer and the map not using color coding. Medical records that cannot be found can be traced by looking at the patient's history of treatment at Simrs Khanza, then looking for the first digit number that is being searched for. When a medical record is not found, a search for the accuracy of the alignment of the medical record is carried out using the medical record tracking method. If a medical record cannot be found, a new medical record will be used temporarily.
Co-Authors Alumni STIKES Husada Borneo Ani Kipatul Hidayah Anisa Batunnajariah Anjar Retno Astrini Carono Daniel Happy Putra Dion Angger Priyatama Diva Angelita Fauziah Irfany Fingky Rizki Wulandari Gussa Azizah Iman Harapan Jaya Zalukhu Laela Indawati Muhamad Al Imran Rangga Putra Muniroh Muniroh Nabila Zahara Ramadan Purwoko, Agus Puteri Fannya Raru, Amida Morina Ratna Auliyana Retno Juwita Rosa Patricia Siswati STIKES Husada Borneo Widjaja, Lily