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All Journal Jurnal Kesehatan Masyarakat Indonesia Jurnal Kesehatan Masyarakat (JKM) CENDEKIA UTAMA Jurnal Sistem Kesehatan Jurnal Ilmiah Universitas Batanghari Jambi Jurnal Akuntansi dan Ekonomika Jurnal Penelitian Pendidikan IPA (JPPIPA) Jurnal Kesehatan Komunitas Jurnal Keperawatan Abdurrab JURNAL PHOTON Jurnal Kreativitas PKM Ensiklopedia of Journal Menara Ilmu Jurnal Manajemen Informasi Kesehatan Indonesia (JMIKI) Viva Medika: Jurnal Kesehatan, Kebidanan dan Keperawatan Al-Tamimi Kesmas: Jurnal Ilmu Kesehatan Masyarakat (Journal of Public Health Sciences) Abdi Dosen : Jurnal Pengabdian Pada Masyarakat PREPOTIF : Jurnal Kesehatan Masyarakat Community Engagement and Emergence Journal (CEEJ) Science Midwifery JPK: Jurnal Proteksi Kesehatan Budapest International Research and Critics Institute-Journal (BIRCI-Journal): Humanities and Social Sciences JESS (Journal of Education on Social Science) Journal of Applied Data Sciences Jurnal Kesehatan Tambusai Jurnal Pengabdian Kesehatan Komunitas (Journal Of Community Health Service) Jurnal Rekam Medis (Medical Record Journal) Jurnal Olahraga dan Kesehatan (Orkes) Jurnal Rekam Medik & Manajemen Informasi Kesehatan (RAMMIK) MARAS : Jurnal Penelitian Multidisplin
Jepisah, Doni
Universitas Hangtuah Pekanbaru
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Evaluasi Screening Dokumen Verifikasi Internal dalam Menentukan Kodingan di Era BPJS Tri Jenny Minarsih; Doni Jepisah; Nofiyadi Nofiyadi
Journal of Education on Social Science (JESS) Vol 9 No 3 (2025): General Issues on Public Service
Publisher : Faculty of Social Science, Universitas Negeri Padang

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24036/jess.v9i3.652

Abstract

The completeness of medical record documents is a critical factor in the internal verification of BPJS Kesehatan claims and the determination of INA-CBGs coding. Incomplete documentation may hinder the coding process, increase the number of pending claims, and delay claim submission, ultimately affecting hospital cash flow. This study aimed to analyze the level of completeness of medical record documents in the BPJS claim verification process at RS Mesra, identify key problems and contributing factors, and formulate solutions along with an improvement intervention plan. This study employed a qualitative approach with a case study design, using direct observation and document review of BPJS claims in the Casemix Unit and Medical Records Unit of RS Mesra. Problem identification was conducted using the Urgency, Seriousness, and Growth (USG) method, while root cause analysis was performed using Fishbone Analysis. A Plan of Action (PoA) was subsequently developed as a system improvement intervention. The findings revealed that the completeness of medical record documents at the internal verification stage remained low. Essential documents, including medical resumes, supporting examination results, treatment summaries, and medication usage logs, were frequently incomplete. The main issues identified included inaccurate ICD-10 diagnosis documentation, the absence of Service Level Agreements (SLA) and Standard Operating Procedures (SOP) for document screening, ineffective inter-unit coordination, and limited functionality of the Hospital Information System (SIMRS) in automatically verifying document completeness. These systemic problems directly contributed to the increasing number of pending BPJS claims. In conclusion, improving medical record completeness requires an integrated approach involving enhancement of human resource competencies, strengthening internal regulations, optimization of SIMRS, and improved inter-unit coordination to support effective BPJS claim management at RS Mesra.
Co-Authors Abidin, dr. Aldiga Rienarti Ade Idra Suhara Ahmad Hanafi Ahmad Hanafi Ahmad Hanafi Alni Diniati Alni Diniati, Alni Anggraini, Gussri Anggraini, Lola Anusirwan Arba’a, Nurhamni Arnawilis Asmarwiati, Septien Astika, Fitriani Astika, Rini Azlina, Azlina budi hartono Budi Hartono Budi Hartono Damayanti, Elok Daniati, Sy. Effi Dedi Afandi Dekrial Dekrial Dessica Noviasari Dewi Sanita Emy Leonita Ennimay Ester Napitupulu, Ervinna Fetty Try Rahmadani Fitriani Astika Fitriani, Ernita Gussri Anggraini H. Ahmad Hanafi, SKM, M.Kes Haili Harnani, Yaessi Haryani Octaria Henny Maria Herman M. Purwonegoro Herniwanti Herniwanti Hetty Ismainar Huda Nuri Suraya, Huda Nuri Imam Slamet Prasetio Irwan Muryanto Julia Citra Sari Kamali Zaman Karnila Ardiyanti Kholida Hosni Kholili, Ulil Kiswanto Kiswanto Kiswanto Kiswanto Lita Lita, Lita Mahmudah Mailisa Dwi Cahayati Maimun, Nur Marlina, Hastuti Megasari, Miratu Misnaimah, Misnaimah Muhamadiah, Muhamadiah Nadia Rista Nofiyadi Nofiyadi Nopriadi Nopriadi nur helmi Nurafni Marissa Nurmala Sari Jambago Nurwidad, Nurwidad Octaria, Haryani Octaria, Haryani Octaria, Haryani Ovi Novianto Siska Priwahyuni, Yuyun Priwahyuni Putri Yahya Rahayu, Endang Purnawati Rani, Novita Rany, Novita Riauni Syaputri Ricardo Ricardo Riri Maharani Rizer Fahlevi Roslia Asrin Rukijah, Siti Septemdelti, Mona Shanti Veroniga Handayani Siti Hasanah Sy Effi Daniati Syamnur, Rizka Amelia Syarafina, Intan Tia Harjianti Tri Jenny Minarsih Tri Purnama Sari Tri Purnama Sari Tuty Syafni Ulil Kholili Via Trisna, Wen Wen Via Trisna Wulandari I, Prima Yang Ma Aisyah Yang Ma Aisyah Yeni Yeni Yessi Harnani Yuda Irawan Yunita, Jasrida Yusneli, Yusneli Zaman, M. Kamali Zapri Salis Zulhenry