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Putri, Riza Suci Ernaman
Universitas Awal Bros
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Compensation Audit Case at Casemix Hospital X Yastori, Yastori; Putri, Riza Suci Ernaman; Khumaira, Nurul Fitri; Oktavia, Dewi
Procedia of Engineering and Life Science Vol. 6 (2024): The 3rd International Scientific Meeting on Health Information Management (3rd ISMoHI
Publisher : Universitas Muhammadiyah Sidoarjo

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21070/pels.v6i0.1966

Abstract

Audit Compensation Audits result in operational activities and hospital financial systems becoming disrupted and unstable. Based on a preliminary survey at Hospital This research aims to analyze Compensation Audit cases carried out by health insurance providers in 2023. The type of research used is using the Mixed Method, a research approach that combines or associates qualitative and quantitative forms. This research was conducted in March - June 2024. The research population was 11 compensation audit cases in 2023. Total sampling technique. An in-depth analysis was carried out on 11 compensation audit cases based on analysis of medical resumes, related regulations and based on ICD-10 and ICD-9-CM coding rules. The results of research that carried out an in-depth analysis of compensation audit cases showed that most compensation audit cases were caused by the enforcement of treatment classes with a total of 3 cases, specific management 2 cases, combination code 1, availability of death reports 1, regulations for enforcing the main diagnosis 1, specific management for main diagnosis 1, unavailability of anatomical pathology attachments 1, errors in establishing the main diagnosis and non-compliance with medical procedures and supporting documents 1. Compensation Audit Case Solution, namely the coder must understand medical records, claim submission documents, ICD-10, ICD-9-coding rules CM, health insurance provider and hospital PPK claim regulations, doctors need to provide clear, specific management and be able to determine the patient's condition. treatment class from the start of entry and the health insurance verifier must have the same perception as the previous verifier and be careful in reading and analyzing the claim submission documents.
SOSIALISASI PENERAPAN DIGITALISASI APPOINTMENT DI RUMAH SAKIT AWAL BROS BATAM Widya Putri; Riza Suci Ernaman Putri; Dinda Astya Monique
JOURNAL OF SUSTAINABLE COMMUNITY SERVICE Vol. 2 No. 1 (2021): DECEMBER
Publisher : Transpublika Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55047/jscs.v2i1.435

Abstract

Indirect registration is conducted online with the aim of reducing patient accumulation caused by lengthy registration times. The online registration system implemented by Awal Bros Hospital Batam offers four options: registration through the Haloawalbros application, Stardok, Chatbot (specifically for online registration via WhatsApp), and the Mobile JKN application for BPJS patients. This study aims to determine the procedures for the online appointment registration system at Awal Bros Hospital Batam. The research methodology includes population sampling techniques and operational definitions of research variables. Based on the research findings, Awal Bros Hospital Batam has successfully implemented an online appointment registration system. Four applications are available for conducting online appointments at Awal Bros Hospital Batam: Haloawalbros, Stardok, Chatbot with WhatsApp, and the Mobile JKN application for BPJS-insured patients.
ANALISIS BERKAS PENDING KLAIM BPJS KESEHATAN PELAYANAN RAWAT JALAN DI RS X BATAM riza suci ernaman putri
Jurnal Kesehatan Medika Saintika Vol 15, No 2 (2024): Desember 2024
Publisher : Stikes Syedza Saintika Padang

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30633/jkms.v15i2.2864

Abstract

Pelayanan di rumah sakit yang mendukung program pemerintah dalam bidang kesehatan yaitu, program Jaminan Kesehatan Nasional (JKN) yang diselenggarakan oleh Badan  Penyelenggara Jaminan Sosial (BPJS). Ketepatan pengiriman berkas rekam medis merupakan salah satu upaya untuk mewujudkan ketepatan pengklaiman BPJS di unit rekam medis, namun karna masih banyaknya berkas rekam medis yang masih kosong dan ditemukan berkas persyaratan tidak lengkap pada pelayanan rawat jalan maka berkas rekam medis dapat beresiko lamanya pengklaiman asuransi, sehingga dapat merugikan rumah sakit karena memperlambat proses pembayaran klaim. Tujuan penelitian ini adalah untuk mengetahui gambaran berkas klaim tertunda pasien rawat jalan BPJS Kesehatan di RS X. Metode penelitian kualitatif deskriptif menggunakan data primer adalah data dari hasil wawancara  dan data sekunder dari telaah dokumen data klaim tertunda pasien BPJS Kesehatan. Dari hasil penelitian didapatkan total pengajuan pada bulan januari, februari, maret 2024 adalah 41.921 berkas BPJS Kesehatan, terdapat 41.776 dengan status layak klaim, 146 pending klaim, dan 0 dispute klaim. Kesimpulan : penyebab terjadinya pending klaim di RS X diantaranya masih adanya berkas yang diajukan belum memenuhi persyaratan klaim BPJS Kesehatan, yaitu berkas tidak lengkap, kesalahan dalam memasukkan kode diagnosis atau prosedur, serta kasus-kasus dalam menangani pasien BPJS Kesehatan masih kurang jelas.
Co-Authors - Yastori, - Dinda Astya Monique Fani Farhansyah Khumaira, Nurul Fitri Kusumo, Retno Larasati, Amelya Hanifah Monique, Dinda Astya Mulyana Mulyana Oktavia, Dewi Putri, Widya Rahmawati Rahmawati Retno Kusumo Sihotang, Ruthdea Pasha siti wulandari Sulaiman, Vhina Triani, Melfina Widya Putri Windharti, Ceriani Yuni Utami