Garuda - Garba Rujukan Digital

Hospital Tariff Gap With Final Claims in The Indonesian Case Base Groups (INA-CBGs) System Warsi Maryati; Indriyati Oktaviano Rahayuningrum; Vega Nevi Astuti
Proceeding of International Conference on Science, Health, And Technology Proceeding of the 1st International Conference Health, Science And Technology (ICOHETECH)
Publisher : LPPM Universitas Duta Bangsa Surakarta

National Health Insurance is a health program organized by the Social Security Organizing Agency with a prospective payment system or package system. Payment for health services with this package system is based on a diagnosis and procedure grouping that has similar resource needs. This study is an analytical study by examining differences in hospital tariff with final claims on the INA-CBG system. Data collection was carried out by observing 100 INA-CBGs claim files in five hospitals in Central Java Province, Indonesia. Data were analyzed by Paired Sample T-test. The results of the study showed that there was a significant difference with p value < 0.001. The total hospital tariff is IDR 582,373,996.00 compared to the total claim rate in the INA-CBG system of IDR 526,431,595.00, resulting in a negative difference of IDR 55,942,371.00. The difference in tariffs reached 9.6% of the total hospital tariff. The percentage of negative difference between hospital tariff and the tariff in the INA-CBGs system is 53%, slightly more than the 47% positive difference. Most hospitals already have efficient health service management by referring to the established clinical pathway. Financial management with cross subsidies between cases with positive and negative tariff differences can help hospital operations to continue to run well. Compliance of health workers with clinical pathways and effective and efficient management of health services can help hospitals overcome losses in the National Health Insurance system.

Disparities in hospital cost and INA-CBGs tariff with unit cost analysis of inpatient services Warsi Maryati; Muhammad Faiz Othman; Siti Musyarofah; Puguh Ika Listyorini; Fhahrul Dwi Aryanti; Miftakhul Jannah
Proceeding of International Conference on Science, Health, And Technology 2021: Proceeding of the 2nd International Conference Health, Science And Technology (ICOHETECH)
Publisher : LPPM Universitas Duta Bangsa Surakarta

The National Health Insurance Program, a form of health insurance that has been implemented since 2014, which uses the Indonesian Case Based Groups (INA-CBGs) system. The implementation of this system ensures that patients get good service and hospitals get standard tariff. The intended tariff is in the form of a package which includes all components of hospital costs. This study aims to determine the relationship between the unit cost of all health service cost components and the INA-CBGs tariff and how the gap is. The research sample was taken from the INA-CBGs claim document in the second quarter of 2020 as many as 4,833. Data were analyzed using linear regression to find a relationship between hospital health service costs and the INA-CBGs tariff. Hospital service costs are calculated based on unit cost analysis. The average unit cost of laboratory was IDR 853,500 (7.91%), radiology IDR 366,198 (3.39%), treatment IDR 2,031,850 (18.82%), Examination IDR 4,205,745 (38.95%), Consumables IDR 345,092 (3.17%), and Drugs IDR 3,022,694 (27.76%). The results of the analysis showed Laboratory (b = 1.639; 95% CI = 1.177 to 2.100; p <0.001), Treatment (b = 0.915; 95% CI = 0.852 to 0.978; p <0.001), Examination and Accommodation (b = 1.211; 95% CI = 1.138 to 1.285; p <0.001), and Drug (b = 0.015; 95% CI = 0.007 to 0.024; p <0.001) had a significant relationship with the INA-CBGs tariff. Other variables such as Radiology (b = -0.141; 95% CI = -0.629 to 0.347; p <0.001) and Consumable Costs (b = -0.343; 95% CI = -696 to 0.009; p <0.001) had no significant relationship with INA-CBGs Tariff. However, all cost components have a significant effect (p <0.001) of 42.7% on the INA-CBG tariff with a strong influence category (R = 0.654). Hospitals must be wiser in managing finances with the INA-CBGs pattern, because the tariff may look small because there are some treatment that are not cost effective or there are still unnecessary treatment for patients taking a large portion of the cost of the package.

Hospital Patient Loyalty: In terms of Brand Image, Service Quality, Patient Satisfaction, and Trust Puguh Ika Listyorini; Warsi Maryati; Sylvia Anjani
Proceeding of International Conference on Science, Health, And Technology 2021: Proceeding of the 2nd International Conference Health, Science And Technology (ICOHETECH)
Publisher : LPPM Universitas Duta Bangsa Surakarta

The success of a hospital if it has loyal patients. Patient loyalty depends on the brand image of the hospital, the quality of service to patients, patient satisfaction, and patient trust in the hospital. This study aims to determine whether there is a relationship between brand image, service quality, satisfaction, and patient trust on patient loyalty. This type of research is analytic observational research with a cross-sectional approach. Samples were taken by accidental sampling with a total of 156 patients. The results showed that there was a relationship between brand image, service quality, satisfaction, and patient trust on patient loyalty.

THE Identification Pending Claim of Healthcare and Social Security Agency Insurance at Nirmala Suri Hospital. Linda Widyaningrum; Warsi Maryati; Rizki Nurul Wulandari
Proceeding of International Conference on Science, Health, And Technology Proceeding of the 3rd International Conference Health, Science And Technology (ICOHETECH)
Publisher : LPPM Universitas Duta Bangsa Surakarta

A pending claim is a claim that is returned by the BPJS (Social Security Administering Agency) Health verifier to the hospital for revision which can later be resubmitted. This study aims to determine the causes of pending BPJS claims for inpatients at Nirmala Suri Sukoharjo Hospital in 2020. This study is a descriptive study, with a retrospective approach. Samples of 685 claims are pending with the saturated sample technique. The research instrument was in the form of observation guidelines and interview guidelines. Data processing with classification, editing, and presentation of data in text form. Data processing with data analysis is done descriptively. The implementation of BPJS patient claims at the Nirmala Suri Sukoharjo Hospital has been implemented and has implemented the existing SPO (Standard Operating Procedures). There are 14 classifications of pending BPJS claims for inpatients at Nirmala Suri Sukoharjo Hospital. The causes of pending BPJS claims for inpatients at the Nirmala Suri Sukoharjo Hospital in 2020 include: completeness of medical record documents, clarity of doctor's writing, and application system updates. Coordinate with related units such as medical records and registration units, inpatient installations, emergency units, cashier units, and pharmacy installations regarding matters that affect pending claims so that they do not happen again. It is better if the coder requires updating the latest knowledge and rules related to coding rules or BPJS Health rules and it takes the accuracy of the coder and grouper in the coding and input process

The Sociodemographic Factors Associated With Multimorbidity In Patients With Diabetes Mellitus Type 2 In District Hospital Sukoharjo Central Java. Oktaviano Rahayuningrum, Indriyati; Maryati, Warsi; Cahya Faiza, Meilia
Proceeding of the International Conference Health, Science And Technology (ICOHETECH) 2024: Proceeding of the 5th International Conference Health, Science And Technology (ICOHETECH)
Publisher : LPPM Universitas Duta Bangsa Surakarta

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47701/icohetech.v5i1.4140

Background: Multiple chronic diseases known as multimorbidity are one of the global public health challenges. Multimorbidity among older adults was more than 50% in different countries. This study aimed to analyze the sociodemographic factors associated with multimorbidity in patients with diabetes mellitus type 2 in District Hospital Sukoharjo Central Java. Methods: This study used a cross-sectional approach utilizing medical record data of diabetes mellitus patients. Consecutive sampling was conducted, and 75 samples were included. A descriptive analysis was performed by reporting percentages. Bivariate analysis was conducted using Chi-square. Logistic regression with a 5% significance level was used to analyze the multivariable. Results: The prevalence of multimorbidity was 33 (44%). The sociodemographic factors associated with multimorbidity were age (p=0.039), gender (p=0.032), education (p=0.028), status of employment (p=0.020), and length of stay (p=0.011). Logistic regression showed an association between length of stay (OR=3.93;95%CI=1.29-11,92; p=0.016) and multimorbidity. Conclusion: Based on these findings, the sociodemographic factors associated with multimorbidity in patients with diabetes mellitus type 2 were: age, gender, education, status of employment, and length of stay. The programs to prevent multimorbidity should be formulated. Early detection and health promotion can be managed to decrease multimorbidity in patients with diabetes mellitus type 2.

Implementation Of Poac Management (Planning, Organizing, Actuating And Controlling) In An Effort To Reduce The Number Of Pending Claims For Inpatient Bpjs In The Hospital Tri Utami, Yeni; Maryati, Warsi; Sri Rahayuningsih, Lilik Anggar
Proceeding of the International Conference Health, Science And Technology (ICOHETECH) 2024: Proceeding of the 5th International Conference Health, Science And Technology (ICOHETECH)
Publisher : LPPM Universitas Duta Bangsa Surakarta

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47701/icohetech.v5i1.4207

Problems with pending claims in hospitals are mostly caused by incomplete files and discrepancies in the accuracy of diagnosis codes. UNS Surakarta Hospital is known to find around 50-300 BPJS Inpatient claim files pending every month. This study aims to determine management in an effort to reduce the number of pending claims for inpatient BPJS patients in hospitals. This type of research is descriptive qualitative, with a cross sectional approach. The subjects of this research include claims coordinators, coders, internal verification officers and medical committee members (doctors). The research object is the claim file for Trimonths 4 of 2023. The instruments used are interview guidelines, observation guidelines, checklists. The research results showed that of the 2289 claim files submitted, 168 files (7.34%) were pending, which were divided into 3 factor classifications, namely Medical Aspects 62 files (36.90%), Administrative Aspects 57 files (33.93%) and Coding Aspect 49 files (29.17%). The process of handling pending claims based on planning, organizing, actuating and controlling aspects is still not running optimally. This is caused by the lack of clear division of job descriptions and the absence of SOPs related to handling pending claims which are only manifested in official notes, in general evaluations are still carried out based on cases but not based on users which causes there to be no rewards and punishments for officers who do not comply. It would be better for hospitals to prepare SOPs for filling out BPJS claim requirements files, and make clear job desk divisions, especially the BPJS coding section, and implement Inpatient RME immediately.

Quality and Efficiency of Health Services in The Implementation of Electronic Medical Records: Bibliometric Analysis Maryati, Warsi; Hartono, Hartono; Puspita Febrinasari, Ratih
Proceeding of the International Conference Health, Science And Technology (ICOHETECH) 2024: Proceeding of the 5th International Conference Health, Science And Technology (ICOHETECH)
Publisher : LPPM Universitas Duta Bangsa Surakarta

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47701/icohetech.v5i1.4252

Background: Electronic medical records (EMR) were growing rapidly because they were believed to improve the quality and efficiency of health services. Literature studies related to EMR have been carried out, but the bibliometric analysis was not yet known. This study aimed to analyze the bibliometrics of research related to EMR and its impact on quality and patient care. Methods: We have carried out bibliometric analysis using VOS viewer and Mendeley on articles from the Scopus database for 2014-2023. Articles have been filtered based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) diagram. We used the keywords electronic medical records, quality and efficiency to search for articles. Articles that were not in English, could not be downloaded in full text and were not related to quality or efficiency were excluded. Articles that met the criteria were analyzed. Results: We obtained 24 articles from the screening results. Most articles in 2020 (6), there was a significant increase in 2019 (4). Most articles have been published in Journal of Medical Internet Research (3). The International Journal of Medical Informatics received the most citations (160 from 2 articles). There were 8 research articles from the United States. The most frequently used keywords were electronic medical record(s). Meanwhile, the issues most commonly associated with the implementation of EMR include; quality improvement, health care quality, patient satisfaction, and cost. Conclusion: Bibliometric analysis was important to carry out in future research to map the characteristics of research with wider data sources.

Alert Features for Healthcare in Increasing Hospital Revenue from DRG Reimbursement: A Systematic Literature Review Maryati, Warsi; Utami, Yeni Tri; Muhtarom, Moch
Proceeding of the International Conference Health, Science And Technology (ICOHETECH) 2025: Proceeding of the 6th International Conference Health, Science And Technology (ICOHETECH)
Publisher : LPPM Universitas Duta Bangsa Surakarta

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47701/3am59z25

The inadequate quality of medical records and theelevated rate of insurance claim denials worldwide havenecessitated the incorporation of alert functionalities intoElectronic Health Record (EHR) systems to enhancedocumentation precision and reimbursementeffectiveness. This research seeks to evaluate the impactof alerts on healthcare professionals' ability to enhancethe quality of medical records (completeness, accuracy,timeliness) and insurance claim results through aSystematic Literature Review (SLR) following PRISMA 2020guidelines. Out of 538 studies sourced from PubMed,Scopus, and Web of Science, 14 were selected based onstrict inclusion criteria. The synthesis of results reveals thatalerts—particularly those integrated with clinical decisionsupport—substantially enhance documentation qualityand decrease claim rejections. The successful execution ofthis integration relies on EHR compatibility, managementbacking, user education, and the alleviation of alertfatigue. These results offer an empirical foundation foroptimizing hospital revenue by improving the quality ofmedical records and the efficiency of claims, althoughadditional research is required in the contexts ofdeveloping countries and for evaluating cost-effectiveness.

The Sociodemographic Factors Associated With Multimorbidity In Patients With Diabetes Mellitus Type 2 In District Hospital Sukoharjo Central Java. Oktaviano Rahayuningrum, Indriyati; Maryati, Warsi; Cahya Faiza, Meilia
Proceeding of the International Conference Health, Science And Technology (ICOHETECH) 2024: Proceeding of the 5th International Conference Health, Science And Technology (ICOHETECH)
Publisher : LPPM Universitas Duta Bangsa Surakarta

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47701/icohetech.v5i1.4140

Background: Multiple chronic diseases known as multimorbidity are one of the global public health challenges. Multimorbidity among older adults was more than 50% in different countries. This study aimed to analyze the sociodemographic factors associated with multimorbidity in patients with diabetes mellitus type 2 in District Hospital Sukoharjo Central Java. Methods: This study used a cross-sectional approach utilizing medical record data of diabetes mellitus patients. Consecutive sampling was conducted, and 75 samples were included. A descriptive analysis was performed by reporting percentages. Bivariate analysis was conducted using Chi-square. Logistic regression with a 5% significance level was used to analyze the multivariable. Results: The prevalence of multimorbidity was 33 (44%). The sociodemographic factors associated with multimorbidity were age (p=0.039), gender (p=0.032), education (p=0.028), status of employment (p=0.020), and length of stay (p=0.011). Logistic regression showed an association between length of stay (OR=3.93;95%CI=1.29-11,92; p=0.016) and multimorbidity. Conclusion: Based on these findings, the sociodemographic factors associated with multimorbidity in patients with diabetes mellitus type 2 were: age, gender, education, status of employment, and length of stay. The programs to prevent multimorbidity should be formulated. Early detection and health promotion can be managed to decrease multimorbidity in patients with diabetes mellitus type 2.

Implementation Of Poac Management (Planning, Organizing, Actuating And Controlling) In An Effort To Reduce The Number Of Pending Claims For Inpatient Bpjs In The Hospital Tri Utami, Yeni; Maryati, Warsi; Sri Rahayuningsih, Lilik Anggar
Proceeding of the International Conference Health, Science And Technology (ICOHETECH) 2024: Proceeding of the 5th International Conference Health, Science And Technology (ICOHETECH)
Publisher : LPPM Universitas Duta Bangsa Surakarta

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47701/icohetech.v5i1.4207

Problems with pending claims in hospitals are mostly caused by incomplete files and discrepancies in the accuracy of diagnosis codes. UNS Surakarta Hospital is known to find around 50-300 BPJS Inpatient claim files pending every month. This study aims to determine management in an effort to reduce the number of pending claims for inpatient BPJS patients in hospitals. This type of research is descriptive qualitative, with a cross sectional approach. The subjects of this research include claims coordinators, coders, internal verification officers and medical committee members (doctors). The research object is the claim file for Trimonths 4 of 2023. The instruments used are interview guidelines, observation guidelines, checklists. The research results showed that of the 2289 claim files submitted, 168 files (7.34%) were pending, which were divided into 3 factor classifications, namely Medical Aspects 62 files (36.90%), Administrative Aspects 57 files (33.93%) and Coding Aspect 49 files (29.17%). The process of handling pending claims based on planning, organizing, actuating and controlling aspects is still not running optimally. This is caused by the lack of clear division of job descriptions and the absence of SOPs related to handling pending claims which are only manifested in official notes, in general evaluations are still carried out based on cases but not based on users which causes there to be no rewards and punishments for officers who do not comply. It would be better for hospitals to prepare SOPs for filling out BPJS claim requirements files, and make clear job desk divisions, especially the BPJS coding section, and implement Inpatient RME immediately.

Title

Found 11 Documents
Search
Journal : Proceeding of International Conference Health, Science And Technology (ICOHETECH)

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Title Search

Found 11 Documents Search Journal : Proceeding of International Conference Health, Science And Technology (ICOHETECH)

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Title

Found 11 Documents
Search
Journal : Proceeding of International Conference Health, Science And Technology (ICOHETECH)