Efforts to Address Pending BPJS Claims for Outpatient Services at Mitra Sehat Situbondo Hospital Using PDCA

Abstract

This community service program aims to improve the quality of BPJS outpatient claim coding at RS Mitra Sehat Situbondo through the application of the PDCA (Plan, Do, Check, Act) method. Initial observations revealed that coding errors led to numerous pending claims. During the planning phase (Plan), an in-depth analysis of the coding issues was conducted, and a training plan was developed covering proper coding techniques and the use of Electronic Medical Records (EMR). The execution phase (Do) involved direct mentoring for staff in the medical records unit. Evaluation (Check) showed a significant reduction in coding errors with an improvement in staff understanding of BPJS coding standards. Corrective actions (Act) included additional training sessions and the development of a continuous monitoring system. The results of this program confirm the effectiveness of the PDCA method in improving BPJS claim management and recommend the implementation of better monitoring systems and ongoing training to ensure long-term improvements