Design of Recapitulation System Pending Inpatient Claims to Enhance BPJS Verification Efficiency Using Extreme Programming
DOI:
https://doi.org/10.35870/ijsecs.v5i3.5229Keywords:
Information System, Pending Claims Recapitulation, Extreme Programming, BPJS Verification, Inpatient Claims ManagementAbstract
This study designs and develops an information system with a centralized database for recapitulating pending inpatient claims at Hospital X Bandung. The system assists casemix officers in optimizing report accuracy, analyzing frequent ineligible claim types, and minimizing recurrent case probability. Hospital X currently employs a conventional Excel-based process lacking centralized analytics for case classification and periodic data management. The research methodology employs Extreme Programming (XP), selected for its rapid iteration cycles, flexibility, and continual improvement capabilities. Data collection combines direct observations, structured interviews with four medical record installation officers, and systematic literature review. The XP approach enables iterative development with continuous user feedback, ensuring the system meets operational requirements. Implementation results demonstrate measurable improvements: processing time decreased by 35%, pending claim rates reduced by 40%, and classification accuracy increased by 75%. The system architecture comprises four modules: data entry, claim case classification, report generation, and dashboard visualization. Each module underwent rigorous testing through Black Box Testing methodology, validating functionality and user experience. Current system constraints include absence of INA-CBGs system integration, advanced data encryption protocols, and cross-network usage capabilities. The standalone desktop architecture limits simultaneous multi-user access. Despite these constraints, the system successfully simplifies recapitulation workflows and establishes a foundation for future development, particularly web-based architecture and predictive analytics integration
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References
Permenkes RI No 3. (2020). Tentang Klasifikasi dan Perizinan Rumah Sakit. Peraturan Menteri Kesehatan Nomor 3 Tahun 2020.
Rosita, N. P. I., Wijaya, W. S., & Mutiarahati, N. L. A. C. (2023). Strategi manajemen rumah sakit dalam meningkatkan kualitas pelayanan pasien. Jurnal Pengabdian Dan Pemberdayaan Masyarakat, 1(2), 28–35. https://doi.org/10.54107/abdimahosada.v1i2.191
Permenkes RI No 24. (2022). Tentang Rekam Medis. Peraturan Menteri Kesehatan Nomor 24 Tahun 2022.
Hasbullah, A. O., Maidin, H. A., & Machmud, N. U. (2024). Implementasi pending klaim BPJS kesehatan berdasarkan Permenkes No 26 Tahun 2021 di RS Ibnu Sina. Journal of Aafiyah Health Research (JAHR), 5(2), 199–209. https://doi.org/10.52103/jahr.v5i2.1699
Utami, Y. T., Soultoni Akbar, P., Amelia, R., & Sari, S. Y. (2024). Faktor penyebab pending klaim BPJS rawat inap dengan penerapan rekam medis elektronik di RSUD Dr. Moewardi Surakarta. In Prosiding Seminar Informasi Kesehatan Nasional (SIKesNas). https://doi.org/10.47701/sikenas.vi.3939
Syahira, N., & Rusdi, A. J. (2024). Strategi optimalisasi klaim jaminan kesehatan nasional di unit casemix rumah sakit "X" Blitar. Jurnal ARSI: Administrasi Rumah Sakit Indonesia, 10(2). https://doi.org/10.7454/arsi.v10i2.1182
Taslim, R. K. A., & Meliala, A. (2022). Mekanisme pengajuan klaim BPJS di Rumah Sakit Umum Siloam Kupang [Master's thesis, Universitas Gadjah Mada]. https://etd.repository.ugm.ac.id/penelitian/detail/230004
Pangidoan Simbolon, R., Wahyudi, B., & Mulyani, K. (2024). Strategi manajerial dalam menangani klaim tertunda BPJS kesehatan di rawat inap Rumah Sakit Pertamina Sorong. EKOMA: Jurnal Ekonomi, 4(1). https://doi.org/10.56799/ekoma.v4i1.6263
Permenkes No 28. (2014). Tentang Pedoman Pelaksanaan Program Jaminan Kesehatan Nasional. Peraturan Menteri Kesehatan Republik Indonesia Nomor 28 Tahun 2014.
Maulida, E. S., & Djunawan, A. (2022). Analisis penyebab pending claim berkas BPJS kesehatan pelayanan rawat inap Rumah Sakit Universitas Airlangga. Media Kesehatan Masyarakat Indonesia, 21(6), 374–379. https://doi.org/10.14710/mkmi.21.6.374-379
Winarti, W. (2022). Description of the claim submitting system of BPJS inpatient at Hospital X in Bandung Regency. Jurnal Teras Kesehatan, 4(2), 63–72. https://doi.org/10.38215/jtkes.v4i2.78
Salina, & Wahab, S. (2024). Analisis data dan faktor penyebab pending klaim BPJS rawat inap guna menunjang ke efektivitasan pengklaiman di RSUD Kota Bandung tahun 2024. Journal of Medical Record Student (JMeRS), 2(1), 56–66. https://journal.piksi.ac.id/index.php/jmers/article/view/1431
Pratiwi, S., Gunawan, E., Abdussalaam, F., & Sukmawijaya, J. (2023). Perancangan sistem informasi rekapitulasi klaim pasien BPJS rawat jalan. MBI, 18(1). https://doi.org/10.33758/mbi.v18i1.567
Weiskopf, N. G., & Weng, C. (2013). Methods and dimensions of electronic health record data quality assessment: Enabling reuse for clinical research. Journal of the American Medical Informatics Association, 20(1), 144–151. https://doi.org/10.1136/amiajnl-2011-000681
Ulil Amri, & Nurwahyuni. (2024). [Title not provided in original references].
Wijayanti, R. A., Dewi, R. D. C., Farlinda, S., & Nuraini, N. (2023). BPJS pending claim settlement strategy in hospital with management approach (Planning, Organizing, Actuating, Controlling). International Journal of Healthcare and Information Technology, 1(1), 28–33. https://doi.org/10.25047/ijhitech.v1i1.3917
Lesmana, A., & Taufik, A. (2023). Development of a BPJS hospital claims monitoring systems via bridging dashboard. Journal of Information System, Informatics and Computing, 7(2), 295. https://doi.org/10.52362/jisicom.v7i2.1274
Chaturvedi, R., Sharma, S., Kirupa Gopalakrishna Pandian, P., & Sharma, S. (2024). Leveraging machine learning to predict and reduce healthcare claim denials. https://doi.org/10.5281/zenodo.13268360
Handayani, H., Wahyudi, B., & Mulyani, K. (2024). Analisis penyebab pending klaim pasien BPJS rawat inap dalam rangka mengoptimalkan pendapatan di RSUD Banten. Action Research Literate, 8(12), 3512–3529. https://doi.org/10.46799/arl.v8i12.2532
Raihan, F. M. (2021). Perancangan sistem informasi rekam medis pada Klinik Saffira Sentra Medika Batam. Jurnal Sains, Nalar, Dan Aplikasi Teknologi Informasi, 1(1). https://doi.org/10.20885/snati.v1i1.7
Najrifatussya'diah, S., Syahidin, Y., & Yunengsih, Y. (2024). Rancang bangun menu konfirmasi sebagai pendukung keputusan klaim jaminan kesehatan nasional menggunakan metode extreme programming. Jurnal Teknologi Sistem Informasi Dan Aplikasi, 7(2), 643–652. https://doi.org/10.32493/jtsi.v7i2.39123
Beck, K. (2004). Extreme programming explained: Embrace change (2nd ed.). Addison-Wesley Professional.
Wibagso, S. S., & Celesta, I. (2022). Extreme programming approach in E-PANJO design to support information management at nursing home. Jurnal Buana Informatika, 13(02), 93–104. https://doi.org/10.24002/jbi.v13i02.5707
Supriyatna, A., & Puspitasari, D. (2021). Implementation of extreme programming method in web based digital report value information system design. International Journal of Information System & Technology Akreditasi, 5(1), 67–75. https://doi.org/10.30645/ijistech.v5i1.116
Abdussalaam, F., & Ramdani, A. (2022). Perancangan sistem informasi manajemen praktek kerja lapangan berbasis web menggunakan metode agile. INFOKOM, 10. http://journal.piksi.ac.id/index.php/INFOKOM
Kustiani, R., Syahidin, Y., & Yunengsih, Y. (2024). Electronic medical record information system design to support the reporting of completeness of BPJS patient medical records with extreme programming method. Jurnal Teknik Informatika (Jutif), 5(4), 11–19. https://doi.org/10.52436/1.jutif.2024.5.4.1976
Zilvia, L., Syahidin, Y., & Sari, I. (2024). Perancangan sistem informasi tindakan operasi guna mengelola laporan 10 besar tindakan berbasis elektronik. Jurnal Teknologi Sistem Informasi Dan Aplikasi, 7(2), 635–642. https://doi.org/10.32493/jtsi.v7i2.39368
Sagita, D., Yunengsih, Y., & Abdussalaam, F. (2024). Desain sistem informasi klaim BPJS pasien penyakit dalam dengan metode V model. Jurnal Teknologi Sistem Informasi Dan Aplikasi, 7(2), 426–434. https://doi.org/10.32493/jtsi.v7i2.38610
Sahir, L., & Wijayanti, R. A. (2022). Faktor penyebab pending claim ranap JK dengan fishbone diagram di RSUP Dr Kariadi. Jurnal Manajemen Informasi Kesehatan Indonesia, 10(2), 190. https://doi.org/10.33560/jmiki.v10i2.480
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