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Analisis Pending Klaim Rawat Inap di Rumah Sakit X Tahun 2025 Vivi Sumarliyanti Ekowati Sugiyanto; Demiawan Rachmatta Putro Mudiono; Novita Nuraini; Dony Setiawan Hendyca Putra
Health & Medical Sciences Vol. 2 No. 3 (2025): May
Publisher : Indonesian Journal Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47134/phms.v2i3.747

Abstract

Pending klaim di Rumah Sakit X sering terjadi akibat ketidaklengkapan atau kesalahan administrasi, medis, dan koding. Pada tahun 2024, tercatat 5,74% klaim rawat inap dan 5% klaim rawat jalan mengalami pending, yang berdampak pada gangguan arus kas, keterlambatan pembayaran, dan penurunan mutu pelayanan. Penelitian ini bertujuan menganalisis faktor penyebab pending klaim rawat inap tahun 2025 berdasarkan variabel kinerja Robbins motivation, opportunity, dan ability. Hasil penelitian menunjukkan dari variabel motivasi, subvariabel reward menjadi penyebab karena penghargaan seperti pujian belum diberikan secara merata kepada seluruh staf, serta belum adanya insentif bagi petugas yang berhasil menyelesaikan klaim tepat waktu. Dari variabel opportunity, kendala ditemukan pada subvariabel job description yang masih kurang lengkap dan tidak terperinci dalam SK. Selain itu, fasilitas kerja bagi koder belum memadai, seperti ketersediaan buku ICD-10 dan ICD-9-CM, komputer, pemindai dokumen, dan printer. Sistem informasi manajemen rumah sakit (SIMRS) yang belum terintegrasi dengan V-Claim dan E-Claim juga menjadi hambatan, ditambah ketiadaan SOP yang mengatur alur verifikasi, dan perbaikan klaim BPJS. Sementara itu, pada variabel ability terdapat petugas yang belum memenuhi kualifikasi pendidikan yang sesuai, serta kurangnya pemahaman mengenai prosedur klaim. Tidak tersedianya pelatihan dan transfer knowledge juga memperkuat kendala dalam pengelolaan klaim pending.
Analisis Faktor Penyebab Ketidaktepatan Kodefikasi Penyakit dan Tindakan di RSUD RAA Soewondo Pati Dwi Nur Setyowati; Novita Nuraini; Maya Weka Santi; Gandu Eko Julianto Suyoso
Health & Medical Sciences Vol. 2 No. 4 (2025): August
Publisher : Indonesian Journal Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47134/phms.v2i4.748

Abstract

Kodefikasi merupakan klasifikasi penyakit yang sejenis kedalam satu grup nomor sesuai dengan ICD 10 untuk penyakit dan ICD 9 CM untuk tindakan. Hasil studi pendahuluan diperoleh data ketidaktepatan kodefikasi ranap sebanyak 22% dan rajal sebanyak 5% dari 60 sampel. Tujuan penelitian ini yaitu menganalisis faktor penyebab ketidaktepatan kodefikasi penyakit dan tindakan pasien BPJS kesehatan ranap berdasarkan aspek predisposing, enabling, reinforcing dan menentukan prioritas penyebab masalah menggunakan USG serta menyusun upaya perbaikan masalah menggunakan brainstorming. Jenis penelitian menggunakan penelitian kualitatif dengan teknik pengumpulan data menggunakan pertanyaan tertulis, wawancara, observasi dan dokumentasi. Subyek penelitian sebagai informan utama 4 koder ranap dan informan pendukung meliputi 1 Verifikator Internal, 1 koordinator verifikator, 1 kepala RM. Hasil penelitian menunjukkan bahwa penyebab ketidaktepatan kodefikasi dari predisposing factor koder tidak paham tanda baca pada ICD, perintah omitcode sesuai PMK 26 Tahun 2021 dan kurang paham syarat penegakan diagnosis sesuai BA kesepakatan bersama. Dari enabling factor sarana, tidak tersedia AC diruang koder dan koder jarang mengikuti pelatihan koding. Dari reinforcing factor tidak ada SOP kodefikasi. Prioritas masalah yang harus diselesaikan adalah tidak adanya SOP kodefikasi, Adapun upaya perbaikan masalahanya adalah menyusun SOP kodefikasi.
Analisis Faktor Penyebab Terjadinya Misfile Rekam Medis di Rumah Sakit Baladhika Husada Jember Roudhotul Falah; Maya Weka Santi; Novita Nuraini; Sabran Sabran; Rika Furi Retnoningrum
Health & Medical Sciences Vol. 2 No. 4 (2025): August
Publisher : Indonesian Journal Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47134/phms.v2i4.758

Abstract

Jumlah misfile di Rumah Sakit Baladhika Husada Jember pada tahun 2022 sebesar 2,85%. Penelitian ini bertujuan untuk mengidentifikasi faktor penyebab terjadinya misfile di Rumah Sakit Baladhika Husada Jember, menganalisis prioritas masalah menggunakan CARL (Capability, Accessibility, Readiness, Leverage), dan upaya perbaikan menggunakan brainstorming. Penelitian ini adalah penelitian kualitatif. Subjek penelitian ini adalah kepala rekam medis, enam petugas filing, dan tiga perawat ruangan Nusa Indah. Teknik pengumpulan data melalui observasi, wawancara, dokumentasi, studi literatur, dan brainstorming. Hasil penelitian yaitu kurangnya pengetahuan petugas, petugas filing yang berlatar belakang pendidikan Sekolah Menengah Atas dan belum pernah mengikuti pelatihan rekam medis, belum disiplinnya petugas, belum terhubungnya komputer di unit filing dengan genset, rak penuh, serta sebagian petugas filing belum memahami dan mengetahui isi dari standar operasional prosedur yang ada. Berdasarkan hasil perhitungan prioritas masalah didapatkan hasil yaitu belum disiplinnya petugas, kurangnya pengetahuan petugas, dan rak penuh. Solusi untuk menyelesaikan masalah yaitu perlu adanya surat keputusan tentang pemberian reward dan punishment bagi petugas, memberikan pelatihan tentang rekam medis kepada petugas, serta melaksanakan retensi dan penyimpanan rekam medis diganti menjadi rekam medis elektronik.
Evaluasi Pelaksanaan Penyimpanan Rekam Medis di Ruang Filing Klinik Unej Medical Center (UMC) Jember Gandu Eko Julianto Suyoso; Sandi Nur Azizah; Novita Nuraini; Indah Muflihatin
Health & Medical Sciences Vol. 2 No. 4 (2025): August
Publisher : Indonesian Journal Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar

Abstract

Penyimpanan rekam medis digunakan untuk pendokumentasian dan pemeliharaan rekam medis kepada pasien yang akan datang kembali ke fasilitas pelayanan kesehatan. Hasil pengamatan di Klinik UNEJ Medical Center Jember menunjukkan bahwa rekam medis yang disimpan tidak semuanya dijajarkan tetapi sebagian disimpan dengan ditumpuk sehingga mengganggu sistem penjajaran rekam medis. Penelitian ini bertujuan untuk mengevaluasi pelaksanaan penyimpanan rekam medis di ruang filing Klinik UNEJ Medical Center (UMC) Jember menggunakan metode evaluasi pendekatan sistem dan RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance). Jenis penelitian ini adalah kualitatif dengan teknik pengumpulan data wawancara, observasi, dan dokumentasi. Subjek penelitian terdiri atas 2 orang petugas rekam medis, koordinator administrasi umum dan kepegawaian, serta koordinator layanan penunjang medis. Hasil penelitian menunjukkan bahwa petugas rekam medis berlatar pendidikan rekam medis dan memiliki pengetahuan mengenai rekam medis. Terdapat rekam medis yang memiliki kerusakan fisik dan tidak setiap rekam medis yang disimpan dilindungi dengan map. Selain itu, masih terdapat petugas lain yang keluar masuk ruang rekam medis. Pelaksanaan penyimpanan rekam medis dapat dikatakan masih belum optimal dan belum sesuai dengan Standar Prosedur Operasional yang berlaku dikarenakan keterbatasan sarana dan prasarana. Saran dari penelitian ini yaitu melakukan perbaikan maupun
Development of VANESA (Virtual Assistant Nutritional Care Centre for Education and Consultation) for Diabetes Mellitus Management Novita Nuraini; Rossalina Adi Wijayanti; Riskha Dora Candra Dewi; Andri Permana Wicaksono
International Journal of Healthcare and Information Technology Vol. 3 No. 2 (2026): January
Publisher : P3M Politeknik Negeri Jember

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.25047/ijhitech.v3i2.6706

Abstract

Diabetes Mellitus (DM) remains a significant public health challenge in Indonesia, with rising prevalence and limited access to personalized nutritional care. The Nutrition Care Centre (NCC) at Jember State Polytechnic offers diet consultation and education services but faces constraints in human resources and client reach, with only 23% of visitation targets met since 2021. To address this gap, this study aims to develop VANESA, a virtual assistant powered by artificial intelligence (AI) and QR code technology to provide accessible, efficient, and contextual education and consultation services for DM patients. The system integrates rule-based and AI-based chatbot functionalities to deliver natural language responses regarding DM management, including dietary guidance, physical activity, and basic treatment advice. It also facilitates telehealth consultations, automated registration via QR code, and seamless integration with the existing Electronic Medical Record (EMR) system. Developed using the Waterfall model of SDLC, VANESA is designed to enhance service accessibility, reduce operational costs, and support continuous monitoring of patient nutritional status. Expected outcomes include a web-based admin system, an AI-driven Q&A chatbot, telehealth features, QR-based registration, and an analytics dashboard. This innovation not only supports the Teaching Factory NCC but also serves as a scalable model for digital health interventions in resource-limited settings. Thus, VANESA is a digital health solution that has a direct and applicable impact, is able to increase service efficiency, expand the reach of nutritional interventions, and can be replicated and scaled sustainably in various health facilities, especially in areas with limited resources.
Pendampingan Optimalisasi Manajemen Asuhan Gizi Pasien melalui Penerapan Electronic Mecial Record (EMR) dengan QR Code dan Whatsapp Bot di NCC Rossalina Adi Wijayanti; Riskha Dora Candra Dewi; Novita Nuraini
SEJAGAT : Jurnal Pengabdian Masyarakat Vol. 2 No. 2 (2025): October
Publisher : P3M Politeknik Negeri Jember

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.25047/sejagat.v2i2.6343

Abstract

The Nutrition Care Center (NCC) at Politeknik Negeri Jember (Polije) functions as a Teaching Factory (TEFA), providing comprehensive nutritional assessment, diagnostic services, nutritional counseling, and tailored dietary plans for clients. Health services, including nutrition, necessitate accurate medical records encompassing patient identification, examinations, treatments, interventions, and other pertinent information. However, NCC's manual paper-based medical records system faces challenges. It uses age-based instead of date of birth-based record numbering, lacks standardized nutrition assessment, and lacks disease code classification. This manual system is prone to damage, loss, and demands considerable time and storage space. Since its establishment in November 2021, NCC has seen a steady increase in both internal and external clients. Collaborations with educational institutions, offices, and senior citizen groups have further boosted visits. To enhance efficiency, NCC plans to implement Electronic Medical Records (EMR) with QR Codes and WhatsApp Bots. This approach aims to simplify access to clients' medical histories, allergies, and previous therapies, while also streamlining record retrieval. EMR integration is vital in managing the complexity of nutritional services and supports NCC's mission to provide high-quality care. This initiative aligns with the 2022 Health Department's Research Masterplan and the development of TEFA services. It also reflects the growing trend of using technology, including mobile apps and Artificial Intelligence, in healthcare services. In summary, the increasing number of clients and collaborative screenings with external institutions have led to complex medical records. NCC recognizes the need for a more efficient system and proposes implementation of EMR with QR Codes and WhatsApp Bots to optimize patient care. The project's outcomes will include publications, videos, and improved partner capabilities in EMR usage for patient nutrition care at NCC.
Hubungan Diabetes Melitus dengan Angina Pectoris Berdasarkan Rekam Medis Pasien Rawat Inap di Rumah Sakit Perkebunan Jember Klinik Ikhda Latifatun; Ervina Rachmawati; Novita Nuraini; Efri Tri Ardianto
Jurnal Rekam Medik & Manajemen Informasi Kesehatan Vol. 3 No. 2 (2024): Oktober
Publisher : Indonesian Journal Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47134/rmik.v3i2.1910

Abstract

Angina pectoris is left chest pain that occurs due to impaired blood flow to the heart, preventing the heart muscle from receiving adequate oxygen. This case ranked third in the top 10 morbidity report at Jember Clinic Plantation Hospital in 2022. The number of morbidity and mortality events of angina pectoris continued to increase from 2020 to 2022. This study aimed to analyze the relationship between diabetes mellitus with angina pectoris based on medical records of inpatients at the Jember Clinic Plantation Hospital. This type of research is quantitative research with a case control study design. The study sample consisted of 164 case and 164 control samples selected using simple random sampling. The results showed that there was a significant association of diabetes mellitus (p value = 0,001) with angina pectoris. The suggestion of this study is that people with diabetes mellitus check their blood sugar regularly to prevent angina pectoris.
Analisis Faktor Penyebab Pending Klaim BPJS Kesehatan Rawat Inap di RS Baladhika Husada Jember Rita Maulana; Gamasiano Alfiansyah; Novita Nuraini; Veronika Vestine
Jurnal Rekam Medik & Manajemen Informasi Kesehatan Vol. 3 No. 2 (2024): Oktober
Publisher : Indonesian Journal Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47134/rmik.v3i2.1911

Abstract

Claims are requests for payment of healthcare service costs by healthcare facilities to BPJS Kesehatan. Hospitals must complete the required documents according to BPJS verification procedures to avoid pending claims. The issue of pending claims still occurs at RS Tk.III Baladhika Husada Jember, with a pending rate of 11.4% from July to December 2023. This study aims to analyze the factors causing pending BPJS Kesehatan inpatient claims at RS Tk.III Baladhika Husada Jember using Robbins’ Performance Theory. This qualitative study collected data through interviews, observations, documentation, and brainstorming. The study found that pending BPJS Kesehatan inpatient claims are caused by motivation factors (lack of a reward system), opportunity factors (absence of job descriptions, insufficient staff for casemix and TPPRI), and ability factors (staff with less than 5 years of experience, lack of knowledge about BPJS inpatient claims). The study concludes that the causes of pending BPJS Kesehatan inpatient claims are motivation, ability, and opportunity factors. Proposed improvements include creating job descriptions, regularly maintaining internet networks, recruiting new staff with medical record qualifications, and providing training to enhance staff knowledge.
Analisis Faktor Risiko Diabetes Mellitus Tipe 2 berdasarkan Rekam Medis Rawat Inap di RS Citra Husada Jember Indah Feby Kusuma Wardani; Ervina Rachmawati; Novita Nuraini; Efri Tri Ardianto
Jurnal Rekam Medik & Manajemen Informasi Kesehatan Vol. 4 No. 1 (2025): April
Publisher : Indonesian Journal Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47134/rmik.v4i1.1917

Abstract

The number of inpatients at Citra Husada Hospital with type 2 DM continues to increase every year until 2023, there were 734 patients. The purpose of this study was to examine how gender, a history of obesity, and a history of hypertension relate to risk factors for type 2 diabetes. Based on medical record data from inpatients at Citra Husada Hospital in 2023, this study sought to examine the association between the occurrence of type 2 DM and risk variables for the disease, including gender, history of obesity, and history of hypertension. This kind of study used secondary data in analytic observational case control methodology. Using basic random sampling, 133 case samples and 133 control samples made up the study sample. descriptive analysis for univariate data analysis and the chi-square test for bivariate data analysis. The results showed variables associated with Type 2 DM, namely a history of obesity (p = 0.000) with a risk of 3.297 times developing Type 2 DM and a history of hypertension (p = 0.020) with a risk of 1.836 times developing Type 2 DM and unrelated variables, namely Gender (p = 0.376).
Perancangan dan Pembuatan Sistem Infomasi Peminjaman dan Pengembalian Rekam Medis di Puskesmas Arjasa Kabupaten Situbondo Nuril Firdausiah; Andri Permana Wicaksono; Novita Nuraini; Bakhtiyar Hadi Prakoso
Jurnal Rekam Medik & Manajemen Informasi Kesehatan Vol. 4 No. 1 (2025): April
Publisher : Indonesian Journal Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47134/rmik.v4i1.1919

Abstract

Medical record service activities at the Arjasa Community Health Center in Situbondo Regency still often experience missfiles. A missfile is a medical record file that is misplaced or not found on the medical record storage shelf in the filling room. This missfile occurs because there is no device that controls the entry and exit of medical records, meaning that incoming and outgoing medical records are not recorded in either the medical record tracer or expedition book. resulting in delays in returning medical records to both inpatient and outpatient units. The time limit for borrowing medical records in the outpatient unit is 1x24 hours and 2x24 hours for inpatient care. To minimize delays in returning medical record data which can result in missfiles, this project aims to design and create an information system for borrowing and returning medical records at the Arjasa Community Health Center, Situbondo Regency. This type of research is Research and Development research using the Waterfall method. Data collection was carried out by interviews, documentation and observation. This research produces a website-based information system for borrowing and returning medical records with the advantage of reminders on WhatsApp users. Program flowcharts, data flow diagrams, and entity relationship diagrams are used in designing this information system, and the black box testing method is used for testing.
Co-Authors Aditya Dwi Arimbi Adlien Rizqo Fadillah Afrizal Noor Abidin Aghasi Hana Faradila Agni Candramawa Sholikha Ahmad Shofi Nur Kholili Akulina Wilanti Alfina Farah Damayanti Ana Nafidatul Khoiroh Andri Permana Wicaksono Angga Rahagiyanto Angga Rahagiyanto Anisah Mahshunah Arga Kanya Dhanastra Ariqpurna Bayu Triatmaja Atika Mima Amalin Atma Deharja Atma Deharja Aulia Nurul Kholifah Avivah Nur Aini Azmia Hanna Zahda Bakhtiyar Hadi Prakoso Dahlia Indah Amareta, Dahlia Indah Day Rahmania Demiawan Rachmatta Putro Mudiono Desnia Sindi Damayani Dewi Risdayanti Dewi Soviatus Zahro Digna Hastika Nandita Dinda Darmawati Donny Adhasari Hasan Dony Setiawan Dony Setiawan Hendica P dony setiawan hendyca putra Dwi Nur Setyowati Dyah Palupi Budiningsih Efri Tri Ardianto Ellena Berliani Elsa Mayori Erna Selviyanti Feby Erawantini Ferly Ferly Fitriani Fitriani Futari Ayu Istikomah Gamasiano Alfiansyah Gamasiano Alfiansyah Gandu Eko Julianto Suyoso Haris Hammaminata Hendyca Putra Hikmah, Faiqatul Hikmatus Surur Ika Rahmadhani Ikhda Latifatun Indah Feby Kusuma Wardani Indah Muflihatin Inggil De Crystal Isye Isyanti Devi Isye Isyanti Dewi Kuni Adilata Maya Weka Santi Meiranda Normarisa Azis Mitha Amelia Rahmawati Mitha Audia Rachma Mochammad Choirur Roziqin Mudafiq Riyan Pratama Muhammad Yunus Najla Kamil Nashrul Kholiqir Rohman Nazilla Ade Nurlia Nelly Yanti Nindasari Okta Imelda Niyalatul Muna Novita Indriyani Novita Yuken Nur Aulia Nur Aprilia Setyoyuni Nur Hasanah Ayu Purnamawati Nuril Amalia Nuril Firdausiah nurmawati, ida Puput Puji Lestari Rachmawati, Ervina Restuti, Arisanty Nur Setia Rika Furi Retnoningrum Riskha Dora Candra Dewi Rita Maulana Rosita Prananingtias Rosita Prananingtias Rossalina Adi Wijayanti Rossalina Wijayanti Roudhotul Falah Sabran Sabran Sandi Nur Azizah Sanuri Istiqamah Sari, Estu Pratika Savira Puteri Wulandari Sedyo Pinerdi Selvia Juwita Swari Septiya Atik Cahyani Sherin Laila Khaza Siti Wafiroh Sonia Putri Haris Fadilah Sustin Farlinda Tyas Errica Dewi Maharani Velynsa Diana Putri Veronika Vestine Vivi Sumarliyanti Ekowati Sugiyanto Yulianti, Adhiningsih Yuni Astuti