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All Journal JURNAL PENELITIAN KESMASY International Journal of Business, Law, and Education
Situmorang, Budi Asih
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Humanities Economics, Econometrics & Finance Education Environmental Science Health Professions Languange, Linguistic, Communication & Media Law, Crime, Criminology & Criminal Justice Neuroscience Public Health Social Sciences Other

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IMPLEMENTASI REKAM MEDIS ELEKTRONIK PADA UNIT RAWAT JALAN DI RSUD X BEKASI Situmorang, Budi Asih; Aziz, Abdul; Subardi, Arda Yunita; Dwinuarisha, Eggie
Jurnal Penelitian Kesmasy Vol 7 No 1 (2024): JURNAL PENELITIAN KESMASY
Publisher : Fakultas Kesehatan Masyarakat Institut Kesehatan Deli Husada Delitua

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36656/jpksy.v7i1.2047

Abstract

Electronic medical records (EMRs) represent a significant technological transformation in Indonesia's national health system, but they still pose challenges. According to Minister of Health Regulation No. 24 of 2022, all health service facilities in Indonesia are mandated to implement EMRs. However, the adoption of EMRs across the country's healthcare facilities has not been uniform. RSUD X has been preparing for the digitization of health services since 2018 by using SIMRS Khanza, but after four years, it has yet to fully implement EMRs. In October 2022, RSUD X transitioned to a new system, SIMRS BJB Hope, and began rolling out EMRs for outpatient services in August 2023. After 10 months of implementation, this initiative was expanded to include inpatient services. The initial results show an improvement in performance indicators for outpatient services, with faster provision of medical record documents in 2023 compared to 2022. However, these improvements still fall short of the Minimum Service Standards outlined in Minister of Health Regulation No. 43 of 2016, indicating ongoing challenges in the effective implementation of EMRs in hospital services.
Analysis of Factors Causing Pending BPJS Health Claims for Inpatients at Kartika Husada Setu Hospital in 2024 Situmorang, Budi Asih; Aziz , Abdul; Hutapea, Fresley
International Journal of Business, Law, and Education Vol. 6 No. 1 (2025): International Journal of Business, Law, and Education
Publisher : IJBLE Scientific Publications Community Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.56442/ijble.v6i1.1051

Abstract

This study is motivated by the high number of pending BPJS Health claims at Kartika Husada Setu Hospital. Pending claims can disrupt the hospital’s cash flow and potentially reduce the quality of healthcare services. The purpose of this research is to identify the factors causing pending BPJS Health claims for inpatient services at Kartika Husada Setu Hospital in 2024. This study employs a qualitative research approach with a retrospective design. Data were collected through in-depth interviews, direct observations, and document analysis. The informants included the hospital director, finance manager, service manager, head of the medical records unit, casemix staff, coder, and heads of inpatient wards. The findings indicate that the primary cause of pending claims is the mismatch in medical indications, accounting for 73 files (79.4%), followed by incomplete documentation in 4 files (4.4%), and inaccurate coding in 15 files (16.2%). The mismatch in medical indications often involves unmet emergency and inpatient criteria, as well as a lack of therapeutic evidence. Incomplete documentation is frequently found in medical summaries, while inaccurate coding results from differing interpretations between the hospital and BPJS Health verifiers. The hospital needs to enhance training for staff involved in the BPJS claims process, optimize the use of electronic medical record systems, improve coordination with BPJS Health verifiers, and establish a quality and cost control team. The implementation of these recommendations is expected to reduce the number of pending claims, thereby improving operational efficiency and the quality of healthcare services provided to patients.
Co-Authors Abdul Aziz Aziz , Abdul Dwinuarisha, Eggie Hutapea, Fresley Subardi, Arda Yunita