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All Journal SOEPRA Jurnal Hukum Kesehatan Jurnal Ekonomi Manajemen Sistem Informasi PREPOTIF : Jurnal Kesehatan Masyarakat Jurnal Kesmas Asclepius Infokes : Jurnal Ilmiah Rekam Medis dan Informasi Kesehatan International Journal Software Engineering and Computer Science (IJSECS) Padma: Jurnal Pengabdian Kepada Masyarakat Barongko : Jurnal Ilmu Kesehatan International Journal of Health Sciences Jurnal Mahasiswa Ilmu Kesehatan Karya Kesehatan Siwalima Jurnal Kesehatan Masyarakat Indonesia (JKMI) Jurnal Riset Sains dan Kesehatan Indonesia International Journal of Psychology and Health Science
Desy Widyaningrum
Politeknik Piksi Ganesha
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Review of Pending Inpatient Claims to Improve the Effectiveness of BPJS Health Claims at Muhammadiyah Hospital Bandung Septian Azis; Desy Widyaningrum
International Journal of Psychology and Health Science Vol. 4 No. 3 (2026): International Journal of Psychology and Health Science (July - September 2026)
Publisher : Greenation Publisher & Yayasan Global Research National

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.38035/ijphs.v4i3.2286

Abstract

Pending inpatient claims under BPJS Kesehatan represent a frequent issue during the hospital claim submission process. Such situations can lead to delayed payments and reduce the overall effectiveness of the BPJS Kesehatan claims process. Pending claims are generally caused by incomplete medical records or supporting medical documentation, administrative errors, and discrepancies between diagnosis and procedure codes. Therefore, evaluating the causes of pending claims is essential to improving the effectiveness of BPJS Kesehatan claims. This study aims to identify the causes of pending inpatient claims and the specific types of errors involved, as well as to examine the measures taken by RS Muhammadiyah Bandung to reduce the incidence of pending claims and enhance claim effectiveness. The findings are expected to provide insight into the causes of pending inpatient claims, common administrative errors, and potential improvement strategies for the hospital.
Tinjauan Efektivitas Pelayanan Rawat Jalan Akibat Down Sistem Pada SIMRS di RS AMC Sidik Muhamad Ridwan; Desy Widyaningrum
Jurnal Ekonomi Manajemen Sistem Informasi Vol. 8 No. 1 (2026): Jurnal Ekonomi Manajemen Sistem Informasi (September-Oktober 2026)
Publisher : Dinasti Review

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.38035/jemsi.v8i1.9748

Abstract

Sistem Informasi Manajemen Rumah Sakit (SIMRS) merupakan elemen vital dalam operasional rumah sakit, namun risiko terjadinya down system tetap menjadi tantangan yang dapat menghambat efektivitas pelayanan rawat jalan. Penelitian ini bertujuan untuk meninjau faktor-faktor yang mempengaruhi efektivitas pelayanan rawat jalan ketika terjadi kegagalan sistem pada SIMRS. Menggunakan metode deskriptif kualitatif melalui observasi dan wawancara, hasil penelitian menunjukkan bahwa efektivitas pelayanan sangat bergantung pada kesiapan sumber daya manusia dalam menjalankan prosedur manual, ketersediaan formulir cadangan, kejelasan komunikasi dari unit IT mengenai durasi perbaikan, serta manajemen beban kerja petugas saat proses rekonsiliasi data pasca-sistem kembali normal. Meskipun prosedur mitigasi umumnya telah tersedia, kendala utama tetap terletak pada penurunan kecepatan pelayanan dan potensi terjadinya kesalahan input manual. Oleh karena itu, manajemen rumah sakit perlu melakukan penguatan infrastruktur teknologi secara preventif serta simulasi rutin penanganan down system guna menjaga stabilitas pelayanan dan kepuasan pasien dalam kondisi darurat teknis.
ANALISIS KUNJUNGAN BERULANG PASIEN LAMA RAWAT JALAN TERHADAP PENDING KLAIM BPJS KESEHATAN DI RUMAH SAKIT MUHAMMADIYAH BANDUNG Devira Ulfah Meilani; Desy Widyaningrum
Jurnal Mahasiswa Ilmu Kesehatan Vol. 4 No. 3 (2026): Jurnal Mahasiswa Ilmu Kesehatan
Publisher : STIKes Ibnu Sina Ajibarang

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59841/jumkes.v4i3.3981

Abstract

Repeated outpatient visits by patients without a clear medical indication contribute to pending claims from BPJS Kesehatan. Based on initial observations at RS Muhammadiyah Bandung, it was found that repeated visits are one of the main reasons for outpatient claims being pending each month. This study aims to analyze the pattern of repeated outpatient visits related to BPJS Kesehatan pending claims and their impact on claims management. The study uses a descriptive qualitative method. Research results show that out of 469 outpatient claims that were pending during the first quarter of 2026, 111 claims were due to repeated visits. Of that number, 82 claims were resubmitted, while 29 claims could not be resubmitted because the diagnosis remained the same without any new treatment, so they were considered follow-up or check-up visits only. It is concluded that repeated visits contribute to pending claims, but there is a need to strengthen documentation and develop an automatic detection system.
Peran Mobile JKN Dalam Meningkatkan Efisiensi Pelayanan Pasien BPJS Rawat Jalan Di RSUD Kesehatan Kerja Provinsi Jawa Barat: The Role of Mobile JKN in Improving the Efficiency of Outpatient BPJS Patient Services at the West Java Provincial Occupational Health Hospital Muhamad Akbar Maulana; Desy Widyaningrum
Barongko: Jurnal Ilmu Kesehatan Vol 5 No 1 (2026): Barongko : Jurnal Ilmu Kesehatan (November)
Publisher : Asosiasi Guru dan Dosen Seluruh Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59585/bajik.v5i1.1694

Abstract

Penelitian ini bertujuan untuk menganalisis peran aplikasi Mobile JKN dalam meningkatkan efisiensi pelayanan pasien BPJS rawat jalan di RSUD Kesehatan Kerja Provinsi Jawa Barat. Penelitian ini menggunakan metode kualitatif deskriptif dengan pengumpulan data melalui wawancara mendalam, observasi, dan dokumentasi. Berdasarkan prinsip saturasi data, informan dipilih secara purposive, yang meliputi empat pasien pengguna aktif, satu petugas keamanan, dan satu petugas rekam medis. Hasil penelitian menunjukkan bahwa implementasi Mobile JKN secara signifikan memangkas waktu tunggu pada tahap administrasi awal, di mana pasien dapat mengambil nomor antrean dari rumah tanpa harus mengantre secara fisik di loket sejak dini hari. Kendati demikian, efisiensi ini terbukti masih bersifat parsial karena belum menyentuh pemangkasan waktu tunggu pada aspek pemeriksaan klinis di poliklinik. Selain itu, ditemukan sejumlah kendala operasional yang menghambat kelancaran sistem, meliputi kebingungan pengguna akibat fitur auto debit, instabilitas infrastruktur jaringan (gangguan server dan keterbatasan kuota harian), serta rendahnya literasi digital pada kelompok lansia. Dapat disimpulkan bahwa Mobile JKN sangat efektif sebagai instrumen efisiensi administrasi pendaftaran, namun optimalisasinya secara menyeluruh mutlak membutuhkan penyempurnaan integrasi sistem informasi (bridging) dan pendampingan proaktif dari petugas bagi pengguna.
Evaluasi Sistem Penyimpanan Rekam Medis Aktif Terhadap Terjadinya Duplikasi Di RSUD Kesehatan Kerja Provinsi Jawa Barat: Evaluation of the Active Medical Records Storage System for Duplication at the West Java Provincial Occupational Health Hospital Muhammad Sirul Majid; Desy Widyaningrum
Barongko: Jurnal Ilmu Kesehatan Vol 5 No 1 (2026): Barongko : Jurnal Ilmu Kesehatan (November)
Publisher : Asosiasi Guru dan Dosen Seluruh Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59585/bajik.v5i1.1708

Abstract

Perkembangan teknologi informasi di bidang kesehatan mendorong rumah sakit untuk menerapkan dua sistem rekam medis, yaitu rekam medis manual dan rekam medis elektronik (RME). Duplikasi rekam medis dapat menghambat kesinambungan informasi pelayanan kesehatan. Penelitian ini bertujuan mengevaluasi sistem penyimpanan rekam medis aktif dan mengidentifikasi faktor penyebab duplikasi di RSUD Kesehatan Kerja Provinsi Jawa Barat. Penelitian dilaksanakan di Instalasi Rekam Medis RSUD Kesehatan Kerja, khususnya pada bagian filing dan pendaftaran Instalasi Gawat Darurat (IGD)/Rawat Inap (Ranap), pada tanggal 1–30 Juni 2026. Penelitian menggunakan metode kualitatif deskriptif dengan wawancara dan dokumentasi terhadap empat informan yang dipilih secara purposive. Analisis data menggunakan model Miles, Huberman, dan Saldaña dengan triangulasi sumber dan teknik. Hasil penelitian menunjukkan sistem penyimpanan telah menggunakan sentralisasi dan Terminal Digit Filing, namun pelaksanaannya belum optimal. Pada Juni 2026 ditemukan 25 duplikasi dari 1.378 kunjungan/pasien, dengan prevalensi 1,81%. Faktor yang berkontribusi meliputi ketelitian petugas, kapasitas penyimpanan, proses peminjaman dan pengembalian berkas, serta sistem informasi hybrid. Optimalisasi diperlukan melalui penguatan SPO, penataan filing, pengendalian berkas, dan peningkatan pemanfaatan SIMRS serta rekam medis elektronik.  
Peran Petugas Rekam Medis Dalam Upaya Optimalisasi Penggunaan Anjungan Pendaftaran Mandiri (APM) Di Rumah Sakit AMC: The Role of Medical Records Officers in Optimizing the Use of Self-Registration Machines (APM) at AMC Hospital Yusuf Firdaus; Desy Widyaningrum
Barongko: Jurnal Ilmu Kesehatan Vol 5 No 1 (2026): Barongko : Jurnal Ilmu Kesehatan (November)
Publisher : Asosiasi Guru dan Dosen Seluruh Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59585/bajik.v5i1.1717

Abstract

Anjungan Pendaftaran Mandiri (APM) diterapkan untuk meningkatkan efisiensi pelayanan pendaftaran rawat jalan, namun pemanfaatannya di Rumah Sakit AMC Cileunyi belum optimal. Meskipun demikian, implementasinya masih memerlukan pendampingan petugas, terutama bagi pasien yang mengalami kesulitan dalam menggunakan sistem.  Kurangnya pemahaman pasien terhadap alur sistem, kesalahan penginputan data, serta tingginya ketergantungan terhadap bantuan petugas Penelitian ini bertujuan menganalisis peran petugas rekam medis dalam optimalisasi penggunaan APM. Penelitian ini merupakan penelitian kualitatif dengan pendekatan deskriptif. Data diperoleh melalui wawancara semi-terstruktur, observasi, dan dokumentasi terhadap satu Kepala Instalasi Rekam Medis, tiga petugas rekam medis, dan dua pasien yang dipilih menggunakan purposive sampling. Data dianalisis menggunakan model Miles dan Huberman. Hasil penelitian menunjukkan bahwa petugas rekam medis berperan dalam memberikan informasi, edukasi, pendampingan, dan bantuan teknis kepada pasien. Kendala utama meliputi rendahnya literasi digital pasien, gangguan jaringan, dan proses bridging BPJS. Penelitian ini menyimpulkan bahwa optimalisasi penggunaan APM memerlukan keseimbangan antara pengembangan teknologi, peningkatan kompetensi petugas rekam medis, dan kesiapan pasien dalam memanfaatkan pelayanan digital. Penyediaan perangkat APM saja belum cukup apabila belum disertai dengan edukasi yang berkelanjutan, penyederhanaan alur penggunaan, evaluasi sistem secara berkala, serta perbaikan infrastruktur pendukung
Analysis Of Morbidity Data Management For The Presentation Of The Top 10 Diseases At The Medical Records Installation Of Hermina Arcamanik General Hospital Nova Rahmadona; Desy Widyaningrum
International Journal of Health Sciences Vol. 4 No. 3 (2026): IJHS : International Journal of Health Sciences
Publisher : Asosiasi Guru dan Dosen Seluruh Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59585/ijhs.v4i3.1700

Abstract

Morbidity data play an essential role in supporting hospital decision-making, program planning, and service quality evaluation. Nevertheless, morbidity data management may be affected by incomplete diagnosis documentation, coding inaccuracies, and delays in data processing. This study aimed to analyze morbidity data management in relation to the preparation and presentation of the top 10 disease report at the Medical Records Installation of Hermina Arcamanik General Hospital. A descriptive qualitative design was employed. Data were collected on March 25, 2026 through direct observation, semi-structured interviews, and document review. One medical records officer directly responsible for morbidity reporting was purposively selected as the informant. The findings showed that morbidity data retrieval had been computerized through the Hospital Management Information System (SIMRS) and Electronic Medical Records (EMR). Data were exported to Microsoft Excel, separated by service type, processed, reviewed, and ranked for routine reporting. The principal problem occurred in outpatient services, where diagnoses were sometimes incomplete, uncoded, or recorded only as follow-up visits because of high patient volume and limited physician practice time. In March 2026, the top 10 outpatient and emergency diagnoses comprised 8,522 cases, whereas the top 10 inpatient diagnoses comprised 1,050 cases. Corrective action was mainly undertaken after incomplete data had been identified. The study concludes that computerized morbidity reporting is already established, but source-data quality, interprofessional coordination, and preventive system controls should be strengthened to improve the accuracy and timeliness of morbidity reports.
Analysis Of The Effect Of Electronic Medical Record Implementation On The Effectiveness Of Outpatient Services At RSUD Kesehatan Kerja Ardian Zhilan Sutanandra; Desy Widyaningrum
International Journal of Health Sciences Vol. 4 No. 3 (2026): IJHS : International Journal of Health Sciences
Publisher : Asosiasi Guru dan Dosen Seluruh Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59585/ijhs.v4i3.1713

Abstract

Electronic Medical Records (EMRs) are health documentation systems that utilize information technology to store, manage, and display patient data electronically. This study aimed to analyze the effect of EMR implementation on the effectiveness of outpatient services at RSUD Kesehatan Kerja. A descriptive qualitative approach was employed. Data were obtained through observation, documentation, and semi-structured interviews with five informants selected using purposive sampling, consisting of one Head of the Medical Records Installation, two medical record officers in the outpatient registration unit, one physician, and one nurse. The findings showed that EMR implementation had a positive impact on outpatient service effectiveness, including increased service speed, easier access to patient information, improved readability and accuracy of data, and better integration among service units. Nevertheless, implementation has not yet been fully optimized because the hospital continues to operate a hybrid system and encounters system downtime and network disruptions. Therefore, EMR implementation contributes to improving the effectiveness of outpatient services; however, stronger infrastructure and greater system stability are still required to achieve more optimal implementation.
Analysis of Coding Accuracy in Supporting Severity Level Determination for INA-CBG's Claims among Inpatients at Muhammadiyah Bandung Hospital Revi Mariska Longa; Desy Widyaningrum
Karya Kesehatan Siwalima Vol. 5 No. 2 (2026): September-February
Publisher : Lembaga Penerbitan Fakultas Kesehatan, Universitas Kristen Indonesia Maluku

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.54639/kks.v5i2.2053

Abstract

Indonesia Case Base Groups (INA-CBG's) is the healthcare payment system used in the implementation of the National Health Insurance (Jaminan Kesehatan Nasional/JKN) program, in which the accuracy of diagnosis and procedure coding forms the basis of the grouping process and the determination of severity levels. Inaccurate coding may result in an inappropriate severity level, which in turn affects the value of INA-CBG's claims. This study aimed to analyze the accuracy of diagnosis and procedure coding in supporting severity level determination for INA-CBG's claims among inpatients at Muhammadiyah Bandung Hospital. This study employed a descriptive method with a quantitative approach, with data collected through observation and a documentation study. The results showed that the number of Severity Level I patients during the first quarter of 2026 was 1,130. Based on length of stay (LOS), most patients were treated for 3-5 days, while only 3 patients had a length of stay exceeding 10 days. These results indicate that the accuracy of diagnosis and procedure coding plays an important role in supporting severity level determination, so that the INA-CBG's claim process can be carried out accurately and in accordance with patients' clinical conditions.
Co-Authors Abdussalaam, Falaah Ade Irma Suryani Ade Irma Suryani Agung Firmansyah Sumantri Agus Alim Ai Susi Susanti Alda Rizma Annisa Ulfah Ardian Zhilan Sutanandra Arfa Izzati Arif Setyawan, Adhita Daniel Budi Wibowo Devira Ulfah Meilani Diansyah Edi Suharto Erix Gunawan Fadillah, Muhamad Adrian Faiz Fadhilah Putra Ihsan Ramadhan Jajat Sudrajat Milla Anjani Mochammad Padhil Zaelani Muhamad Akbar Maulana Muhammad Sirul Majid Nadia Rizki Pratami Narjati Soejoto, Nina Nova Rahmadona Novia Pitryani Nuke Dewi Utami Hamid Nursipa Nursipa Nurul Huda, Ilham Putri Maharani, Aqissa R Iqbal Taufik Nugraha Ramdhan Gunawan Revi Mariska Longa Sali Setiatin Sani Nurfadilah Santy Christinawati Septian Azis Shinta Elvira Sidik Muhamad Ridwan Sri Haryati Syaban Agandi Syaikhul Wahab Syntya Dewi Tedy Hidayat Thesalonika, Lona Triadi, Ahmad Diaz Wahab, Syaikhul Wahyu Trimastuti Yayang Ayu Nuraeni Yohanes Budi Sarwo Yuda Syahidin Yusuf Firdaus Yuyun Yunengsih