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All Journal COMSERVA: Jurnal Penelitian dan Pengabdian Masyarakat The Journal of Society Medicine (JSOCMED)
Wirdah, Wirdah
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Humanities Economics, Econometrics & Finance Education Health Professions Immunology & microbiology Industrial & Manufacturing Engineering Medicine & Pharmacology Neuroscience Social Sciences

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Analisis Klaim Pending BPJS Kesehatan di RSUD Pasar Minggu Tahun 2024 Wirdah, Wirdah; Soewondo, Prastuti; Kartika Dewi, Endah
COMSERVA : Jurnal Penelitian dan Pengabdian Masyarakat Vol. 5 No. 2 (2025): COMSERVA: Jurnal Penelitian dan Pengabdian Masyarakat
Publisher : Publikasi Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59141/comserva.v5i2.3234

Abstract

Based on the results of the verification of claims at Pasar Minggu Hospital, the number of pending claims at the end of 2024 has increased both in terms of the number of claims and the cost of claims. In hospitals with a JKN service level of > 80%, the occurrence of pending claims can affect the hospital's cash flow. This study aims to analyze data on pending claim cases to be able to map the group of causes of pending cases. The method of writing the article used is a quantitative cross-sectional design, which is an approach based on data collection that can present information in a short time. As a result, the average number of pending cases at Pasar Minggu Hospital is 5.45% of the total number of claim files filed in 2024, while when viewed from the amount of pending claims, it reaches 17.13%. In inpatient services, the percentage of pending claims based on the number of files on average reached 1.02% and 15.48% when viewed from the value of claims. On the other hand, in outpatient services, the average number of claims based on files is higher, which is 4.43% and in terms of claim value, the portion is 1.66%. The cause of pending claims when reviewed from the number of files is the most due to the aspect of administrative completeness, which is 45.07%. Meanwhile, when viewed from the amount of cost or claim value, the group that caused the most pending claims was due to the aspect of coding rules at 44.10%. The factors that cause pending claims at Pasar Minggu Hospital consist of four factors: human (the service team and casemix have varying levels of understanding of coding and medical aspects, money (the budgeting process for updating coding knowledge and skills is not routine), method (the autoclosing system in the outpatient file claim process, in the inpatient claim process, the coding process is carried out at the end of the service), material (PPK updates have not been done regularly, so there are still variations in services), and machines (the coding system in SIMRS is still done with manual input).
Analisis Klaim Pending BPJS Kesehatan di RSUD Pasar Minggu Tahun 2024 Wirdah, Wirdah; Soewondo, Prastuti; Kartika Dewi, Endah
COMSERVA : Jurnal Penelitian dan Pengabdian Masyarakat Vol. 5 No. 2 (2025): COMSERVA: Jurnal Penelitian dan Pengabdian Masyarakat
Publisher : Publikasi Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59141/comserva.v5i2.3234

Abstract

Based on the results of the verification of claims at Pasar Minggu Hospital, the number of pending claims at the end of 2024 has increased both in terms of the number of claims and the cost of claims. In hospitals with a JKN service level of > 80%, the occurrence of pending claims can affect the hospital's cash flow. This study aims to analyze data on pending claim cases to be able to map the group of causes of pending cases. The method of writing the article used is a quantitative cross-sectional design, which is an approach based on data collection that can present information in a short time. As a result, the average number of pending cases at Pasar Minggu Hospital is 5.45% of the total number of claim files filed in 2024, while when viewed from the amount of pending claims, it reaches 17.13%. In inpatient services, the percentage of pending claims based on the number of files on average reached 1.02% and 15.48% when viewed from the value of claims. On the other hand, in outpatient services, the average number of claims based on files is higher, which is 4.43% and in terms of claim value, the portion is 1.66%. The cause of pending claims when reviewed from the number of files is the most due to the aspect of administrative completeness, which is 45.07%. Meanwhile, when viewed from the amount of cost or claim value, the group that caused the most pending claims was due to the aspect of coding rules at 44.10%. The factors that cause pending claims at Pasar Minggu Hospital consist of four factors: human (the service team and casemix have varying levels of understanding of coding and medical aspects, money (the budgeting process for updating coding knowledge and skills is not routine), method (the autoclosing system in the outpatient file claim process, in the inpatient claim process, the coding process is carried out at the end of the service), material (PPK updates have not been done regularly, so there are still variations in services), and machines (the coding system in SIMRS is still done with manual input).
Clinical Utility of Procalcitonin for Stratifying Severity in Sepsis Secondary to Pneumonia Saputra , Wachyoe Hadi; Prima, Agus; Wirdah, Wirdah
Journal of Society Medicine Vol. 5 No. 1 (2026): January
Publisher : CoinReads Media Prima

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.71197/jsocmed.v5i1.253

Abstract

Introduction: Procalcitonin (PCT) is a biomarker that reflects the systemic inflammatory response to bacterial infections and has been widely studied in the context of sepsis. In patients with pneumonia, early identification of the severity of sepsis is essential for appropriate clinical management and prognostic evaluation. This study aimed to assess the clinical utility of serum procalcitonin levels in stratifying sepsis severity in patients with pneumonia. Methods: This analytical cross-sectional study was conducted between February 2013 and March 2014 in the Emergency Department and Internal Medicine Wards of Dr. Zainoel Abidin General Hospital in Banda Aceh, Indonesia. Thirty patients diagnosed with pneumonia were enrolled in this study using quota sampling method. Serum procalcitonin levels were measured and categorized according to the severity of sepsis. Statistical analysis was performed using one-way analysis of variance (ANOVA), followed by the least significant difference (LSD) post-hoc test using the SPSS software. Statistical significance was set at P < 0.05. Results: Serum procalcitonin levels progressively increased with increasing severity of sepsis. The lowest PCT level was observed in patients with pneumonia without sepsis (0.091 ng/mL), followed by those with sepsis (0.686 ng/mL), severe sepsis (3.593 ng/mL), and septic shock (21.703 ng/mL). Significant differences in PCT levels were found across the severity groups (P < 0.05), indicating a strong relationship between elevated procalcitonin levels and worsening clinical severity. Conclusion: Serum procalcitonin levels correlate with the severity of sepsis in patients with pneumonia and may serve as a useful biomarker for sepsis severity stratification and clinical risk assessment.
Co-Authors Agus Prima, Agus Kartika Dewi, Endah Prastuti Soewondo Saputra , Wachyoe Hadi