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All Journal Media Ilmu Kesehatan Journal of Hospital Administration and Management (JHAM) Jurnal Kesehatan
Yastori
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Decision Sciences, Operations Research & Management Health Professions Medicine & Pharmacology Nursing Public Health

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Concordance Between Physician’s Clinical Diagnostic Terminology and ICD‑10 on Surgical Patient Medical Records Khumaira, Nurul Fitri; Yastori; Kader, Shaola Syafrullah
MEDIA ILMU KESEHATAN Vol 14 No 3 (2025): Media Ilmu Kesehatan
Publisher : Universitas Jenderal Achmad Yani Yogyakarta

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30989/mik.v14i3.1771

Abstract

Background: The accurate use of medical terminology in clinical diagnosis is crucial for proper disease classification, coding accuracy, and reliable health data reporting. However, inconsistencies remain due to non-standard terminology and abbreviations that do not comply with the International Classification of Diseases (ICD-10).Objective: This study aims to evaluate the conformity of physicians’ diagnostic terminology with ICD-10 and with the hospital’s official abbreviation guidelines.Methods: This descriptive quantitative cross-sectional study was conducted from March to July 2025 at RSKB Ropanasuri Padang. A 96 surgical patient medical records from 2024 were selected through simple random sampling. Diagnostic data were evaluated using a conformity checklist based on ICD-10 Volume 1 and 3 and the hospital’s standardized abbreviation guidelines.Results: : The results showed that not all diagnoses complied with ICD-10 terminology or abbreviation guidelines. Common discrepancies included non-standard abbreviations, inconsistent anatomical terminology, and non-specific terms such as “tumor” without further details.Conclusion: Concordance Physician’s diagnostic terminology with ICD-10 and Abbreviation guidelines remains inadequate. Strengthening standard operating procedures, enhancing clinician training in ICD-10 nomenclature, and establishing more structured coder–clinician communication are essential to ensure valid and reliable health data.
ANALISIS KASUS PENDING KLAIM SEBAGAI DASAR PERANCANGAN APLIKASI AUDIT KODING INTERNAL DI RUMAH SAKIT Yastori; Khumaira , Nurul Fitri
Journal of Hospital Administration and Management (JHAM) Vol 6 No 1 (2025): Journal of Hospital Administration and Management (JHAM)
Publisher : LPPM Universitas Awal Bros

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.54973/jham.v6i1.795

Abstract

Pending claims in hospitals impact cash flow constraints, increase verifier workloads, and disrupt operational stability and service quality. This study aims to analyze pending claims cases as a basis for designing a claims audit application in hospitals. The type of research used in this study is descriptive quantitative research, namely research that uses numbers to describe, explain, and draw conclusions from a phenomenon. Research with quantitative methods uses research data in the form of numbers for statistical processing of frequency distributions, calculating data percentages and analyzing pending claims cases based on BPJS regulations and ICD-10 and ICD-9-CM coding rules. The population of the study was 616 cases. The sample in this study was 15 pending claims cases determined by the Purposive Sampling technique. The results of this study obtained the main problems of pending claims at Hospital X include coding errors, incomplete mandatory supporting documents (examination results, PA, microbiology), and differences in perception with BPJS, can be minimized through strategic solutions in the form of increasing accuracy in reviewing medical record documents and claims to ensure completeness, compliance with regulations (BA, PMK, ICD), and building a strong perception of equality between DPJP and all verifiers. Further research is recommended for the design of prototypes and web-based applications that are fully functional, so that they can be used in real life in the internal claim audit process to minimize pending claims in hospitals.
Causes and Solutions for Pending Cases of Outpatient Claims at RS X Bukittinggi Yastori
Jurnal Kesehatan - STIKes Prima Nusantara Vol 15 No 3 (2024): Jurnal Kesehatan Volume 15 Nomor 3 Tahun 2024
Publisher : LPPM Universitas Prima Nusantara Bukittinggi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35730/jk.v15i3.1199

Abstract

Pending claims have an impact on the delay in payment of medical services which has an impact on the performance of hospital employees, thus affecting the quality of hospital services. The purpose of this study was to determine the causes and solutions to pending cases of outpatient claims at X Bukittinggi Hospital. The study was conducted in February-September 2023 in the Casemix and medical records unit. The population of this study was 2,627 pending claim cases in 2023. The sample in the study used the Slovin formula, obtaining a sample of 91 pending outpatient claim documents. The research design is a qualitative study of outpatient pending claim document review and in-depth interviews. The causing pending claims for inpatient care consisted of errors in the coding process by the coder and the coding input process by the grouper, errors in placing primary and secondary diagnoses on the medical resume, unclear writing on the CPPT, incomplete medical resume, confirmation of supporting evidence in establishing the primary and secondary diagnoses, evidence of supporting examinations, confirmation of diagnosis establishment for exceptional cases that occur because there are indications determined by the doctor after the results of further examinations, regulations in determining the category of treatment class, compliance with related regulations. Pending claim solutions include understanding BPJS claim regulations and related regulations that regulate things like codification rules and rules related to completeness of documents.
Co-Authors Kader, Shaola Syafrullah Khumaira , Nurul Fitri Khumaira, Nurul Fitri