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All Journal Indonesian of Health Information Management Journal (INOHIM) Jurnal Kesehatan Tambusai PELS (Procedia of Engineering and Life Science)
Bella, Cindy Rozza
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Computer Science & IT Control & Systems Engineering Dentistry Electrical & Electronics Engineering Engineering Health Professions Medicine & Pharmacology Nursing Public Health

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Analysis Of Pending Claims For Inpatients Social Security Organizing Body (Bpjs) Health Hospital Mitra Siaga Tegal: Analisis Pending Klaim Pasien Rawat Inap Badan Penyelenggara Jaminan Sosial (Bpjs) Kesehatan Rumah Sakit Mitra Siaga Tegal Indira, Zahrasita Nur; Yustafia, Atiqah Filda; Wijayanti, Wahyu Nur; Bella, Cindy Rozza; Mulyani, Agustina Dwi; Wibowo, Dimas Ari
Procedia of Engineering and Life Science Vol. 7 (2025): Prosiding Seminar Nasional dan Rakernas PORMIKI X
Publisher : Universitas Muhammadiyah Sidoarjo

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21070/pels.v7i0.2237

Abstract

The Hospital understands and realizes the importance of the claim process as a reimbursement for insurance patients who have been treated. pending claims, namely the return of claims where there is no agreement between BpJS Health and FKRTL regarding coding and medical rules (dispute claims), but settlements are carried out in accordance with statutory provisions. Mitra Siaga Tegal Hospital in September 2022 obtained data that there were 94 pending BPJS claim files for inpatients out of 1427 files that had been submitted for claims to BPJS. This is due to coding errors, incorrect data entry, incomplete supporting examinations such as the absence of therapy and laboratory results. The method used in this research is qualitative with in-depth interviews with the Assistant Manager of Insurance Control and the officer in charge of Inpatient Claims at Mitra Siaga Tegal Hospital. The purpose of this study was to find out the causes of pending claims for hospitalization in September 2022 at Tegal Mitra Siaga Hospital. The results of the study show that pending cases of inpatient BPJS claims at Mitra Siaga Hospital in Tegal can occur due to several factors, which consist of administrative, medical, and coder aspects. The most common factor causing pending hospitalization claims was the coder aspect in 76 cases
ANALISIS KELENGKAPAN PENGISIAN LAPORAN OPERASI PADA REKAM MEDIS PASIEN BEDAH SARAF DI RUMAH SAKIT X BANDUNG Bella, Cindy Rozza; Budiyanti, Shifa Amanda
Jurnal Kesehatan Tambusai Vol. 6 No. 1 (2025): MARET 2025
Publisher : Universitas Pahlawan Tuanku Tambusai

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.31004/jkt.v6i1.43361

Abstract

Laporan operasi penting untuk menjamin mutu tindakan medis, penggantian biaya pelayanan kesehatan oleh asuransi kesehatan sampai untuk kepentingan di pengadilan. Laporan operasi harus lengkap 100% sesuai dengan Standar Pelayanan Minimal rekam medis. Tujuan dari penelitian ini adalah mengetahui kelengkapan pengisian laporan operasi pasien bedah saraf di Rumah Sakit X Bandung. Jenis penelitian ini adalah deskriptif kuantitatif. Populasi dalam penelitian ini sebanyak 600 rekam medis pasien bedah saraf bulan Januari – Juni 2024. Menggunakan rumus slovin didapatkan sampel sebanyak 86 rekam medis. Pengumpulan data menggunakan tabel ceklis observasi. Hasil penelitian menunjukkan kelengkapan pengisian laporan operasi pasien bedah saraf bagian identifikasi pasien sebesar 99,5%, bagian laporan penting sebesar 96,3%, bagian autentikasi sebesar 99,67%, dan bagian pendokumentasian yang benar sebesar 93,67%. Berdasarkan hasil wawancara, faktor ketidaklengkapan pengisian laporan operasi adalah belum adanya SOP pengisian laporan operasi, ketidaktelitian dokter atau perawat dalam mengisi laporan operasi, serta belum optimalnya rekam medis elektronik dalam mendukung pengisian laporan operasi secara elektronik. Kelengkapan pengisian laporan operasi di Rumah Sakit X Bandung sudah dapat dikatakan bagus, tetapi masih belum optimal karena persentase kelengkapan belum mencapai 100%.
Evaluasi Sistem Informasi Manajemen Puskesmas (SIMPUS) dengan Pendekatan HOT-Fit Model di Puskesmas Baturraden II Bella, Cindy Rozza; Ummah, Shofiatul; Isnaeni, Rizka
Indonesian of Health Information Management Journal (INOHIM) Vol 13, No 1 (2025): INOHIM
Publisher : Lembaga Penerbitan Universitas Esa Unggul

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47007/inohim.v13i1.660

Abstract

SIMPUS is an application designed to manage public health centers (Puskesmas), specifically created to handle patient data from registration to report generation. Generally, the implementation of SIMPUS in Baturraden II Public Health Center has AbstractSIMPUS is an integrated information system that supports service management in Community Health Centers (Puskesmas), covering processes from registration to reporting. At Baturraden II Community Health Center, the system has been generally implemented; however, outpatient services still face efficiency challenges due to technical and operational issues. This study aims to evaluate the effectiveness of SIMPUS using a descriptive quantitative approach and the Human, Organization, Technology–Fit (HOT-FIT) framework. A total of 20 healthcare workers participated as the sample in data collection conducted in December 2023. The evaluation covered human aspects (competence, acceptance, satisfaction), organizational aspects (policies, leadership support, and support from the Health Office), and technological aspects (system development, system quality, and service quality). The findings indicate that although SIMPUS has been utilized for documentation and reporting, obstacles such as reliance on external servers and unstable internet connections still hinder smooth service delivery. Periodic evaluations are needed to improve system integration and service efficiency at the Community Health Center.Keyword: evaluation, SIMPUS, HOT-FIT modelAbstrakSIMPUS merupakan sistem informasi terintegrasi yang mendukung pengelolaan layanan di Puskesmas, mulai dari pendaftaran hingga pelaporan. Di Puskesmas Baturraden II, sistem ini telah diimplementasikan secara umum, namun pelaksanaan layanan rawat jalan masih menghadapi kendala efisiensi akibat gangguan teknis dan operasional. Penelitian ini bertujuan untuk mengevaluasi efektivitas SIMPUS dengan pendekatan kuantitatif deskriptif menggunakan kerangka kerja Human, Organization, Technology–Fit (HOT-FIT). Sebanyak 20 tenaga kesehatan dilibatkan sebagai total sampel dalam pengumpulan data yang dilakukan pada Desember 2023. Evaluasi mencakup aspek manusia (kompetensi, penerimaan, kepuasan), organisasi (kebijakan, dukungan pimpinan dan Dinas Kesehatan), serta teknologi (pengembangan, mutu sistem, dan kualitas layanan). Hasil penelitian menunjukkan bahwa meskipun SIMPUS telah digunakan untuk pencatatan dan pelaporan, masih ditemukan hambatan seperti ketergantungan terhadap server eksternal dan koneksi internet yang tidak stabil, yang berdampak pada kelancaran pelayanan. Diperlukan evaluasi berkala guna meningkatkan integrasi sistem dan efisiensi layanan di Puskesmas.Kata Kunci: evaluasi, SIMPUS, model HOT-FIT
Overview of the Causes of BPJS Health Pending Claims Due to Inaccuracy of Diagnosis Codes in Sebelas Maret University (UNS) Hospital Bella, Cindy Rozza; Pratama, Aldi; Abidin , Arif Zaenal
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.v6i1.1933

Abstract

In submitting a BPJS Health claim, not all submitted documents can be claimed. Claim status is declared ineligible or pending. A pending claim occurs if the claim file submitted by the hospital is incomplete or does not comply with the requirements set by BPJS Health. Delayed claims can disrupt hospital cash flow and cause losses for the hospital and BPJS Health participants. This research aims to describe the causes of pending claims at UNS Hospital. This research is a quantitative descriptive study with a population of 182 inpatients pending claim documents at UNS Hospital for the period August-October 2023. The sample for this research is 78 pending claim documents based on diagnosis code verification. The sampling technique is total sampling. Based on the data obtained, the number of documents with coding confirmation is 78 pending claim documents s or 11.3% of the total pending claims in the period August – October 2023. This data shows that the majority of pending claim documents are due to inaccurate diagnosis. The factor causing pending claims from BPJS Health inpatients at UNS Hospital occurs due to differences in perception between hospital staff and BPJS Health and is not purely due to coder error, but due to a lack of supporting data as a diagnosis enforcer which affects the accuracy of the code.
Co-Authors Abidin , Arif Zaenal Budiyanti, Shifa Amanda Indira, Zahrasita Nur Isnaeni, Rizka Mulyani, Agustina Dwi Pratama, Aldi Ummah, Shofiatul Wibowo, Dimas Ari Wijayanti, Wahyu Nur Yustafia, Atiqah Filda