/ Hospital management
Everyone knows that interest in artificial intelligence (AI) in healthcare has never been more evident, but I want to propose a reflection on how it is actually used.
Read the articleAt a high-complexity private hospital, the diagnostic measured, across five fronts, how much revenue the institution produced but could not bill.
Read the case/ Healthcare technology
Brazil has world-class medicine running on an administrative infrastructure that would embarrass any other industry. This manifesto is more than a proposal: it is a diagnosis and a plan.
Read the article
From intention to execution: how to use AI in hospital management
Everyone knows that interest in artificial intelligence (AI) in healthcare has never been more evident, but I want to propose a reflection on how it is actually used.
Technology vendors need to share the risk
By Bruno Brasil, Head of Product at Rivio
Agora Tem Especialistas: how a hospital can join
Agora Tem Especialistas is now law and connects private hospitals to the care of SUS patients, with payment through tax credits or debt offsets. See how accreditation works and what changes in the hospital’s billing.
RIS in radiology: how it affects the revenue cycle
The RIS organizes scheduling, reports and billing for imaging services, acting as the link between radiology and the revenue cycle. See how the system works, the difference between RIS and PACS and why this integration reduces denials
Manchester Triage System: colors, time targets and why it matters
The Manchester Triage System organizes care by severity, not by order of arrival. See what each color means, the waiting time targets and why the classification also supports the hospital’s urgent and emergency care billing
How the CBHPM Table calculates physician fees
The CBHPM physician fee combines the value of the procedure’s tier with the operational cost calculated in UCO. See the full formula, the UCO value currently in force and a practical step-by-step calculation example in the hospital
Surgical tier classification: clinical vs. CBHPM
There are two surgical tier classifications: the clinical one, used in care planning, and the CBHPM one, used for billing. See the criteria for each and why confusing them creates a risk of error in hospital billing
RN 566/2022: care deadlines and the impact on the hospital
RN 566/2022 sets the maximum deadlines a health plan has to guarantee care, from a basic consultation to an elective admission. See the deadlines by type of procedure and why the hospital’s schedule directly affects compliance.
RN 503/2022: what the contract with the payer must include
RN 503/2022 requires a written contract between hospital and payer, with minimum clauses on authorization, billing and denials. See what the contract must contain and the risk of operating without these clauses clearly defined
Health plan reimbursement: know the rules
When the patient opts for reimbursement, the hospital bills the patient directly, not the payer. See which documents prevent reimbursement from being denied, what the ANS deadline is and how this routine differs from billing through the health plan
Waiting period portability: what changes for the hospital
Waiting period portability lets plan members switch plans without restarting waiting periods, but the hospital cannot assume the payer has accepted the request. See the requirements of ANS Normative Resolution 438/2018 and how to confirm the patient’s portability
ONA certificate: how the process of obtaining it works
The ONA certificate attests that hospitals and clinics follow the healthcare industry’s quality and safety standards. See how the process of obtaining it works, how long it is valid at each level and why it also protects hospital billing.
Hospital administration: what it is and how to structure management
Hospital administration coordinates a hospital’s care, financial and operational areas. See its main fronts, who is responsible for each one and how technology has been changing this management routine.
RN 649/2025: what changes in billing for self-managed plans
In effect since July 2026, RN 649/2025 expands network sharing among self-managed plans and requires tighter control over eligibility. See the denial risks the change brings to hospital billing and how to prepare
CBHPM and AMB tables: what they are and how to apply them
Discrepancies between the table used for billing and the one set in the contract are among the main causes of denials. See how to identify the version in force, apply the calculation correctly and protect hospital billing
Retrospective audit: what it is and how it reduces denials
Performed after the patient’s discharge, a retrospective audit reviews the entire hospital claim. See how the process works, how it differs from concurrent audit and how it strengthens hospital billing
Physician fee for an ICU specialist consultation: how to bill
A specialist consultation requested by the intensivist in the ICU follows a specific CBHPM rule, different from the fee for a standalone visit. Understand how to value and document this charge
Is ICD a mandatory field on the SADT form? Find out
Many hospitals fill in ICD codes in fields of the SADT form out of habit or because of informal payer requirements. The official structure of the TISS standard, however, calls for a free-text clinical indication, not a structured ICD code. Understand the difference
Home hospitalization: ANS rules, coverage and billing
Home hospitalization replaces a hospital stay when the patient is clinically stable and the home has adequate infrastructure. Understand the ANS rules, the payer’s obligations and how to structure billing without denials
Physician fees in private rooms and the ICU: when to double the tier
Charging double the fee for a stay in a private room or the ICU is not automatic. The CBHPM defines exactly when this doubling is valid and when it can lead to a denial
Hospital logistics: what it is, how it works and how to improve it
Home hospitalization replaces a hospital stay when the patient is clinically stable and the home has adequate infrastructure. Understand the ANS rules, the payer’s obligations and how to structure billing without denials
Health plan contracts: what should be reviewed
The contract with the payer is the document that sets the financial terms of the relationship between hospital and health plan. Reviewing its clauses carefully is what separates a contract that protects the hospital from one that exposes it
Comprehensiveness in healthcare: what it is and how it applies
Understand how this fundamental principle organizes the provision of preventive and curative care in the SUS (Brazil’s public health system) and also influences models of care in private healthcare.
OPME denials: why they happen and how to prevent them
An OPME denial rarely questions whether the material was used. It questions whether the documentation proves it was used, authorized and traced. Learn where the risks are and how to control them
Average time to payment for hospitals: how to reduce it
The average time to payment is the indicator that shows how long the hospital takes to turn care into revenue. Learn how to calculate it and what drives it
OPME: the impact of these materials on hospital costs
OPME (implants and special materials) combines high unit value, strict traceability requirements and a high risk of denial. Learn what they are, how they are regulated and what the hospital needs to control
Denial resolution rate: how to calculate and interpret it
Knowing how many denials are generated is not enough. The resolution rate shows how much the hospital manages to recover, and that is the number that guides how the process is managed
Outpatient billing: rules, forms and how to prevent denials
Outpatient procedures follow different billing rules from hospital stays: different forms, no daily rate and their own authorization logic. Learn how to structure this process without errors
How much does it cost to audit a hospital claim?
The right question is not how much it costs to audit a claim, but how much it costs not to. Understand the components of hospital audit costs and how automation changes that equation
Medication denials: causes, prevention and how to appeal
Medication denials happen for different reasons: a dosage mismatch, a missing authorization, an incomplete administration record. Each cause calls for a different response
Healthcare needs doctors. And engineers
Much of healthcare professionals’ time today is not spent caring for people, but sustaining a bureaucracy that should be invisible
Long hospital billing times: how to reduce them
The average time to payment for Brazilian hospitals was 77.35 days in 2024, according to the Anahp Observatory 2025. Understand why this number is so high and which levers reduce the time between discharge and payment
Hospital audit documentation: what the claim must contain
Most documentation denials could be avoided if the claim reached the payer complete. See what needs to be present in each category of item, from hospital stay to surgery
Hospital routine: understand the processes, standards and departments
The hospital routine defines who does what, how and when in each department of the hospital. Understand how it is structured, which departments make it up and how standardizing processes reduces errors and protects revenue
Clinical denial: what it is and how it differs from a technical denial
Of the three categories of hospital claim denial, the clinical one is the hardest to appeal: it does not question a coding error but the indication for the procedure itself. Learn how to identify it and what to do
High-cost hospital claims: how to submit them without errors
A high-cost claim concentrates the items with the highest value and the highest risk of denial. Building and submitting this type of claim without errors requires a rigorous process at every stage, from documentation to coding
Hospital underbilling: how to identify invisible losses
Unlike a denial, underbilling leaves no trace: the hospital delivers the care but does not charge what it could. Understand the causes and how to identify these losses before they become permanent
Health plan coverage denial: what can be done
Coverage denials affect both the patient and the hospital’s revenue. Understand the difference between prior and subsequent denials, what the provider can do directly and what depends on action by the plan member
What TISS is and why it is essential for hospitals
The TISS standard organizes all communication between providers and private health plans, from billing to denial appeals. Learn what it is, how it works and what changed with TISS 4.01
Hospital prospective audit: what it is and how it reduces denials
A prospective audit acts before the claim is sent to the payer, correcting inconsistencies while it is still possible to intervene. See how to structure this process and what it means for the revenue cycle.
Medical auditing: regulations and how to work in the field
CFM (Federal Council of Medicine) Resolution No. 2,448/2025 updated the rules for medical auditing in Brazil, prohibiting denials of pre-authorized procedures and reinforcing the attending physician’s autonomy. Understand what has changed
Auditing high-cost claims: critical points
High-cost claims combine high clinical complexity with a high risk of denial. Learn what to audit in surgeries with OPME, ICU stays, cancer treatments and high-complexity procedures
Denial appeal deadline: what the rules say
Brazilian regulation does not set a single deadline for disputing denials: each contract sets its own rules. Learn what the ANS requires and where hospitals go wrong in controlling this process
Concurrent audit: a checklist for the hospital stay
Concurrent audit identifies discrepancies during the hospital stay, before they become denials. See what to check in the medical record, procedures, materials, daily rates and care team
Hospital billing by type of care: what changes
Oncology, surgical procedures, ICU and clinical admissions have different forms, tables and authorization processes under the TISS standard. Understand what changes in each type of care and where billing errors are concentrated
Hospital billing checklist: what to check and submit
Registration data, authorization, coding, clinical documentation and contract compliance: the five blocks every billing team should check before sending the batch to the payer
Hospital processes: when management improves care
Patients don’t see processes — but they feel it when processes fail. Understand how a hospital’s internal workflows affect the patient journey and what process management can do to make care more consistent
Hospital process management: why it drives efficiency
Poorly designed processes cost revenue, margin and investment capacity. Learn what hospital process management is, which critical workflows it covers and how to put it into practice
Hospital auditor: the financial impact of the role
The hospital auditor is described by what they do, but rarely by what they represent financially. Understand the three fronts where their work delivers results and how each one affects the hospital’s revenue cycle
Fraud in private healthcare: how hospitals protect themselves
The hospital is rarely the author of fraud in private healthcare, but it is often the path. Learn the warning signs in billing and how preventive auditing protects the institution
Hospital billing errors: how big is the loss?
Denials, rework, time to payment: every hospital billing error has three costs that are rarely calculated together. Understand the financial impact of each type and where to act first
Hospital denial indicators: how to measure and reduce losses
Initial denials of 15.89%, accepted denials of 1.96%: the gap between the two numbers is where hospital management wins or loses. Understand which indicators to monitor, how to calculate them and how to turn them into action.
Hospital business intelligence: how to use data in management
Hospitals produce data at scale, but few turn it into decisions. Understand how hospital business intelligence (BI) integrates clinical, operational and financial information to support strategic management
Reasons for health plan denials: how to avoid financial losses
Coding errors, documentation failures, missing prior authorization: understand why health plan denials happen, the financial impact of each cause and which controls reduce losses before they occur
Revenue cycle: financial impact and how to avoid losses
R$ 5.8 billion withheld in denials, an average time to payment of 78 days and a falling EBITDA margin: understand where the hospital revenue cycle fails, how much each bottleneck costs and what efficient management changes in the bottom line
ANS sets an adjustment cap of 5.11% for individual plans in 2026
The lowest cap since 2000 was approved by the ANS board on May 29, 2026. Understand the calculation methodology, who is affected and the impacts on hospital management
What INTS is and why it is a benchmark in hospital management
The National Institute of Technology and Health manages hospitals, polyclinics and public health programs across the country, with a focus on innovation, quality of care and financial sustainability
Hospital indicators: the main ones and how to apply them
From the denial rate to the occupancy rate, hospital indicators are what separate management by intuition from management by data. See which ones to monitor, how to apply them day to day and what the industry’s numbers reveal about hospitals’ financial risks
Smart hospital: how technology improves management
This is the hospital model in which technology, data and processes work in an integrated way. See how AI, IoT and automation transform hospital management and what Brazil is already doing in this direction
Interoperability: how to apply it in hospital management
Fragmented systems cost repeated tests, avoidable denials and decisions made with incomplete information. Understand how interoperability solves this problem and how the HL7 and FHIR standards are being adopted in Brazil
AI for medical diagnosis: how it works and where it is already used
Artificial intelligence is already transforming medical diagnosis in specialties such as radiology, oncology and reproductive medicine. Understand how the augmented intelligence model works and what Brazilian regulation requires
AI for physicians: how to use the technology in practice
AI use among physicians is already established, but only 9% are at institutions with official adoption. Learn about the main tools available, what CFM Resolution No. 2,454/2026 requires and the limits every professional needs to know
Coverage denial: what it is and how to appeal it
A coverage denial occurs when the payer refuses payment, claiming the item is not covered by the contract or by the ANS coverage list. Learn when the denial is justified and how to structure the appeal to recover withheld revenue
Artificial intelligence in healthcare: a hospital revolution
More than 70% of healthcare professionals already use AI to some extent, but only 9% work at institutions with official adoption. Understand what is changing, where the technology delivers results and what it means for hospital management
Billing for enteral nutrition: rules, TUSS and how to prevent denials
Enteral nutrition has specific classification rules in TUSS, requires multiprofessional documentation and can generate preventable denials. Understand how to structure billing correctly and protect the hospital’s revenue cycle
ICD-11 in Brazil: what changes in hospital billing
ICD-11 brings 17,000 new codes and takes effect in Brazil in January 2027. For hospitals and clinics, the transition goes far beyond updating systems: it affects diagnosis coding, billing to health plans and the risk of denials
Surgical center management: how to avoid losses and denials
Cancellations, idle rooms and documentation failures are silent sources of revenue loss in the surgical center. Understand which indicators to monitor and how technology turns this department into a financial advantage for the hospital
How to issue Anvisa’s AFE Certificate: step by step
Learn what Anvisa’s AFE Certificate is, which companies need one and how to issue it through the Solicita System. A practical, up-to-date guide.
Multiple procedures in the same surgery: how to calculate
Billing for two or more procedures in the same surgical act follows specific CBHPM rules. Understanding the percentages by access route prevents denials, ensures correct billing and protects the hospital’s revenue.
Rivio Manifesto: efficient hospitals save more lives
Brazil has world-class medicine running on an administrative infrastructure that would embarrass any other industry. This manifesto is more than a proposal: it is a diagnosis and a plan.
Hospital billing: what it is, how it works and how to improve it
Hospital billing turns every service provided into revenue, but failures at any stage of the cycle result in denials, delays and invisible losses. Learn the complete process and the practices that protect the hospital’s cash flow
Medical gas calculation: how to bill correctly
Medical gases are classified as medicines by Anvisa and require the same documentation rigor in billing. Learn how to calculate consumption, code correctly in TUSS and avoid the most common denials from health plans
RPA in healthcare: how to automate hospital processes
Manual processes take up to 30% of hospital administrative teams’ time. See how Robotic Process Automation eliminates rework, speeds up billing and reduces denials in the hospital revenue cycle
Artificial intelligence in hospital auditing: what changes
Initial denials reached 17% of billing in 2025, an all-time record. Manual auditing can no longer keep up with the volume. AI reads medical records, detects underbilling and generates denial appeals automatically, covering 100% of patient encounters
Healthcare compliance: a strategic function for billing
Hospitals that operate out of compliance lose revenue, face multimillion fines and risk being removed from payer networks. Learn how a compliance program protects the operation and strengthens your institution’s revenue cycle
SUS Table update: what has changed
Law 14,820/2024 established the first mandatory annual adjustment to the SUS Table in more than a decade. Learn what the December 2024 ordinances put into effect, what has not yet reached hospitals and what the new payment model provides for
What is PHC? Understand its principles and importance
From the Declaration of Alma-Ata to the Family Health Strategy: understand the principles of primary health care, how it works in Brazil and its direct impact on hospital planning
Hospital accreditation: what it is, ONA levels and why it matters
From ONA Level 1 to Level 3: understand how hospital accreditation organizes care processes, strengthens clinical documentation, reduces technical denials and creates the conditions for a more solid and predictable revenue cycle
Hospital billing under SUS and private health plans: the differences
Two payment models, two completely different billing logics. Learn what changes in documents, tables, deadlines and rules when the payer is the government or a private health plan
Family and community physicians: their role and impact on healthcare
From prevention to hospital planning: the role of the family and community physician in reducing costs and avoidable hospital stays in the health system.
Hospital manager: what the role is, what they do and how much they earn
From care planning to the revenue cycle: see what a hospital manager does, which skills they need and how much they earn on average in Brazil
Cardiogenic shock: what it is and how to manage care
Mortality between 30% and 50%, long hospital stays and high-complexity claims: learn how to structure care for cardiogenic shock and protect the hospital’s revenue cycle.
Claims submission: how to avoid stress on submission day
The monthly hospital billing close concentrates pressure, rework and denial risk into a single day. Understand why this happens and how to reorganize the process so that submission is a confirmation, not a race
Hospital compliance: how to ensure conformity
Hospital compliance goes beyond following rules: it is a strategy to protect revenue, prevent fraud and ensure the institution’s financial sustainability in an increasingly regulated industry
Healthcare Mission: Rivio calls on those who want to change healthcare
Rivio launches Healthcare Mission, a summer program (in the Northern Hemisphere) for Brazilian students abroad who are willing to help fight inefficiency in hospital management in Brazil
Rivio Talent: Filipe Xavier, Principal Software Engineer
Filipe Xavier works at Rivio as a Principal Software Engineer, leading the architecture and development of the scalable distributed systems that form the backbone of the company’s technology.
Hospital auditing: what is it and how is it done?
Hospital auditing ensures that every procedure performed is correctly recorded and billed by the hospital. Understand how it works in practice, what types exist and how it protects billing against denials
Hospital financial indicators: which ones to track
Falling revenue per discharge, rising denials and payer delinquency above 60%: data from the Anahp Observatory 2025 shows why monitoring the right hospital financial indicators makes all the difference.
Hospital operational efficiency: how to improve results
Falling revenue per discharge, flat expenses and denials above 15%: the data shows that hospital operational efficiency has become a condition for survival. See six practices to reduce costs and improve results without compromising care.
Hospital auditing: a complete guide for managers
Rising denials, long payment times and fragmented processes erode hospital revenue. Learn how to structure efficient hospital auditing to protect billing and ensure the sustainability of the revenue cycle
Concurrent hospital auditing: what it is and how to do it
Denials generated during the hospital stay are the hardest to recover because the moment for correction has passed. Learn how concurrent hospital auditing acts in real time and protects billing before the claim is closed
Hospital billing specialist: the routine and challenges of the profession
The hospital billing specialist is the professional who makes sure every procedure performed turns into actual revenue: learn about their routine, the main obstacles in the field and the good practices that reduce denials and rework
Administrative and technical denials: what are the differences?
Not every denial has the same origin. Knowing how to tell an administrative denial from a technical one defines where the hospital should act to reduce losses and keep the same errors from recurring in the next billing cycle
Health plans and the CNJ: agreements to reduce litigation
Technical cooperation between the regulator and the judiciary aims to establish solid scientific criteria for judicial decisions, giving companies greater operational predictability and plan members greater legal certainty
How to avoid hospital claim denials: six essential practices
Most hospital claim denials stem from predictable, avoidable failures. See six essential practices to reduce the denial rate before the claim is submitted and protect the institution’s revenue
Stages of the hospital revenue cycle: how to follow them to the letter
Carrying out the stages of the revenue cycle is not enough. They need to be structured with defined protocols, owners and indicators. See what each stage requires to run efficiently and how to measure the cycle’s performance
Hospital billing specialist salary in 2026
The hospital billing specialist career is among the most in-demand in the healthcare sector. See the updated 2026 figures on salary by region, company size and experience level, with official data from CAGED
What the hospital revenue cycle is: a complete guide
From scheduling to payment, the hospital revenue cycle determines how much the hospital actually receives for what it produces. Understand each stage, the main points of loss and how good management transforms the institution’s financial results
Hospital billing specialist: who they are and what they do
From the medical record to payment: the hospital billing specialist is the person who makes sure every service provided turns into revenue for the hospital. Understand their duties, the profile required and how to build a career in the field
Rivio at Hospitalar 2026
Rivio will be at Hospitalar 2026 with an interactive simulation that uses your hospital’s data to show the real impact of denials on revenue. Visit the booth to see everything Rivio’s solution can do
Authorization errors: a major risk for oncology
In oncology, a single authorization error can lead to six-figure denials. Learn the three critical moments where hospitals lose revenue and how to build an effective prevention process into the billing cycle
Administrative denial: what it is and how to avoid it
Understand how registration errors, contractual discrepancies and documentation inconsistencies affect the hospital revenue cycle, and learn practical strategies to reduce financial losses and rework in billing.
How the CBHPM code is structured
Learn to identify price discrepancies between billing and payers’ contract tables to reduce payment refusals and protect the integrity of cash flow through pre-submission audits
Denial code table: codes, meanings and how to use it
The denial code table defines the codes payers use to deny or reduce payments. Knowing each code is the first step to correcting errors before submission and disputing refusals quickly.
TUSS table: what it is and why it matters so much
This table standardizes the language between hospitals and health plans. Learn how TUSS codes work in practice, what the table’s categories are and how coding errors directly affect billing
Denial appeals: how to control and recover amounts
The denial appeal is the main mechanism for recovering revenue refused by payers. Learn how to build solid appeals, which situations are most likely to be reversed and how to organize internal control of the process
Claim denials: what they are and how to prevent them
Learn how claim denials affect hospital billing and discover practical prevention strategies, from standardizing processes to using artificial intelligence to eliminate losses.
Rivio Talent: Gustavo Caruso, Head of Deployment
A Computer Science graduate of Unicamp who also studied at the University of Waterloo through the Science without Borders program…
AI use cases in medical auditing
From reading the medical record to drafting denial appeals, AI works at every stage of medical auditing, reducing losses and making sure the hospital gets paid for everything it delivered
Medicine and AI: more technology, more humanity
Artificial intelligence and the new generation of physicians: an inevitable transformation
Hospital financial efficiency: how to identify losses
A long time to payment, billing rework and incomplete records are signs that the hospital’s financial cycle has room to improve. See how to identify each of these points and what to do about them
How to optimize hospital RCM: practical strategies
From pre-admission to denial appeals, learn how to structure each stage of the hospital revenue cycle to identify invisible losses, reduce denials and increase financial predictability in hospital management
Automation in hospital auditing: what AI does
AI automation has changed what the audit team does, not who it is. Learn which processes to delegate to technology, which to keep under human judgment and how to structure this transition at your institution
SIMPRO table: what it is and how it works in practice
SIMPRO is the main pricing reference for hospital materials in contracts with payers. Learn what it covers, how it works in practice and why coding errors lead to denials with a high financial impact
Hospital financial efficiency: 5 practical changes
Denials, payment times, outdated contracts and unmonitored indicators: see how five operational changes tackle the main points of loss in the hospital revenue cycle
What the Brasíndice table is and how it affects billing
Brasíndice is the main drug price reference in hospital contracts. Learn how PF and PMC work, why the biweekly update is critical and how pricing errors lead to avoidable denials
Hospital billing software: how to choose
From HIS and ERP systems to RCM platforms with AI agents: learn what each technology does, how they differ and what to evaluate before making this decision at your hospital
Hospital financial management: best practices and indicators
From budget planning to denial control: learn the pillars, indicators and best practices that build solid hospital financial management and prepare the hospital to grow with confidence
How to use the TISS table: 10 practical applications
The ANS TISS standard goes far beyond a regulatory requirement: applied strategically, it organizes billing, reduces denials and increases the hospital’s financial predictability. See how to explore its full potential
Key takeaways from HIMSS and SXSW for healthcare
The Rivio Blog spoke with Rafael Elustondo and Gustavo Meirelles, who attended two major global events on health, culture and technology in Las Vegas and Austin, respectively. Find out what lessons they brought back with them
TISS 4.01: what changed and how to adapt your billing
Brazil’s National Supplementary Health Agency (ANS) has updated the TISS standard to version 4.01, mandatory since December 2024. Learn what changed in the terminologies and organizational components, and what your hospital needs to review to avoid denials and rejections
Catheter flushing in hospitals: when to charge and how to avoid denials
Peripheral venous catheter flushing is performed several times a day but rarely charged rigorously. Learn when the procedure can be billed, what must be in the medical record and how correct documentation prevents denials
How the CBHPM code is structured
Learn the fundamentals of the Brazilian Hierarchical Classification of Medical Procedures, which organizes billing by criteria of complexity and technology and is essential to the financial balance between providers and payers
Hospital claim denials: a complete guide for healthcare managers
From the initial rejection to the appeal: learn how to classify, monitor and prevent hospital claim denials at every stage of the revenue cycle, with data from the Anahp Observatory and best practices validated by the market
Revenue Cycle Management: why does this concept matter?
Learn how this governance model helps organize the hospital revenue cycle, reduces denials, improves cash flow and protects financial margins in a regulated and highly complex environment
Hospital billing management: challenges and best practices
From admission to payment: see how to organize the hospital billing department, overcome the most common bottlenecks and use technology to ensure the hospital receives everything it is entitled to
Five hospital billing errors and how to avoid them
From the closing schedule to team skills: see which operational failures do the most damage to hospital billing and how each one can be corrected with processes and technology
Technology for hospital auditing: essential tools
NLP, predictive analytics, RPA and real-time dashboards: the four technology layers that turn hospital auditing from a partial check into a continuous, preventive process
Reasons for hospital claim denials: how to identify and resolve them
Understand the most common reasons for payment refusals in private healthcare and learn practical strategies to prevent hospital billing errors, ensuring revenue cycle compliance and stable cash flow
Hospital billing KPIs: what to measure and why
Average time to bill, first pass rate, return rate: the indicators that live inside the revenue cycle and show, before the month closes, where the process is failing
Hospital denial rate: how to calculate and interpret it
An indicator calculated consistently shows whether the problem is growing, which payer accounts for the most cases and where the internal process needs to be adjusted before the impact reaches cash flow
Guide to medical auditing and hospital billing
Getting hospital billing wrong is expensive, and this e-book shows how to get it right. Find the answers to 13 real billing and auditing questions, based on the CBHPM, the TISS standard and ANS rules
Anti-denial manual: a guide to increasing revenue
Understand the main causes of claim denials, how to interpret them and what to do to prevent them before submission. An e-book that helps auditors and billing specialists work with compliance and efficiency
Hospital revenue cycle: how AI can fix errors
Your hospital is losing revenue in silence. This e-book shows the main errors made during the hospital revenue cycle and how to change the course of the story with the help of Rivio’s artificial intelligence solutions
What is the number of views in the CBHPM used for?
Understand what the number of views column in Chapter 4 of the CBHPM is, how it guides the composition of imaging tests and why applying it correctly prevents denials in hospital billing
How anesthesiologist fees are calculated
Understand how the CBHPM anesthesia tier scale works, how it corresponds to procedure tiers and how to correctly calculate the anesthesiologist’s fee in hospital billing
Hospital revenue cycle management: the complete guide
From pre-admission to payment: learn the stages of the hospital revenue cycle, the indicators that matter and how to structure a process that protects revenue and reduces denials
Hospital billing automation: how to implement it
From process diagnosis to choosing a solution: a practical guide for hospitals that want to automate billing, reduce denials and recover revenue with artificial intelligence
When to bill the surgical technologist fee?
Learn when the surgical technologist fee can be billed, how to calculate the amount based on the CBHPM surgical tier and which common errors lead to denials of this charge
Concurrent or retrospective audit: what are the differences?
Two models, different moments and different impacts on billing: learn how concurrent and retrospective audit complement each other in protecting the hospital revenue cycle
Hospital financial indicators: the main KPIs
In a sector that deals with thin margins and growing denials, monitoring the right financial indicators makes the difference between anticipating problems and reacting too late. Learn which KPIs every hospital manager needs to track and turn into action
How to reduce claim denials: strategies for hospitals and clinics
With denials reaching nearly 16% of revenue in 2025, hospitals and clinics need to go beyond after-the-fact appeals. Learn the strategies that act at the root of the problem and protect the revenue cycle before the claim is submitted
10 points of attention in hospital financial management
Discover the factors that most affect hospitals’ financial results and how to avoid losses, improve processes and increase efficiency with data-driven decisions and strict control of costs and revenue
Hospital visits in private rooms: rules for charging double
The CBHPM provides for doubling the tier value for procedures performed in superior accommodation, but the rule has exceptions. Learn when it applies to code 10102019 and how correct classification protects the hospital’s revenue
AI use in hospitals is informal in 91% of cases
A survey by Instituto Opinion Box, in partnership with Rivio, shows that the use of artificial intelligence in hospitals is still poorly integrated into the institutions’ formal management processes
Stockouts: how to avoid this mistake in healthcare management
Understand how failures in supply planning compromise patient safety and cause financial losses. Discover practical strategies to optimize the supply chain and ensure operational predictability at your facility
Zero inventory in hospitals: can the concept be applied?
Discover how hospital management and data technology resolve the dilemma between patient safety and financial efficiency, turning supply control into a strategic advantage for billing
Fee for service or pay for performance: what are the differences?
Understand how fee for service works and why payers and hospitals have been adopting value- and performance-based models to improve clinical results, raise the quality of care and make private healthcare more sustainable.
Inventory management: how to apply it in hospitals
Understand how hospital inventory control has evolved from an administrative task into a strategic system that connects logistics, patient safety, clinical traceability and financial sustainability in healthcare institutions
What is anamnesis and how it affects hospital management
Understand why this tool is not only clinical but also operational and strategic in hospital management: structured data collection reduces denials, optimizes the revenue cycle and ensures the institution’s legal and clinical safety
Ebserh and its management role in university hospitals
Meet the public company created to modernize the management of federal university hospitals, find out how it operates, what its relationship with SUS is and how many institutions make up this strategic healthcare network in Brazil
Rules for medical auditing: CFM Resolution 2,448/25 explained
Understand the new rules and guidelines for medical auditing, the ethical limits of the auditor and how this function ensures the financial sustainability and technical quality of healthcare institutions
ERP in healthcare: how to think about the concept in hospital management
Understand how enterprise resource planning integrates processes and why healthcare institutions need analysis layers to avoid denials, automate auditing and ensure financial sustainability
AI use in medicine: what the CFM resolution says
CFM Resolution 2,454/2026 seeks to regulate the use of artificial intelligence in medical practice, ensuring the physician’s final authority, patient safety and the ethical use of AI as a support tool in healthcare institutions
Medication scheduling: what it is and why it matters
Understand how good management of medication administration times in the hospital ensures effective treatment, prevents waste of high-cost supplies and optimizes the care team’s productivity
Healthcare management indicators: which matter most?
Learn how to select and interpret the key metrics that connect clinical efficiency to the institution’s financial success and learn how artificial intelligence can make processes more efficient
Materials and Sterilization Center: management best practices
Learn how efficient materials processing prevents surgery cancellations, extends the useful life of surgical instruments and ensures compliance with Anvisa RDC 15, turning the department into a financial pillar of the hospital
World’s best hospitals in 2026: Brazil in the spotlight
The World’s Best Hospitals 2026 ranking places 7 Brazilian hospitals in the global Top 250 and highlights a decisive edge: the consistent, structured use of artificial intelligence to support clinical decision-making and care governance
Choosing Wisely: the art of choosing wisely
Find out how this philosophy transforms hospital management by fighting waste, optimizing the use of tests and strengthening patient safety through value-based clinical decisions grounded in scientific evidence
Surgical suite: a major challenge for hospital management
Understand how hospital management should run the surgical center with a focus on patient safety, strict OPME control, maintenance of critical equipment and optimized room turnover for high performance
The patient’s medical record: what it is and why it matters
Learn about this central instrument for continuity of care and patient safety, which provides legal backing for the team, compliance with the LGPD (Brazil’s General Data Protection Law) and financial sustainability through accurate data documentation
Nursing admission: the starting point of care
The first care contact defines risks, organizes priorities and structures the care plan, affecting safety, operational efficiency and the quality of clinical outcomes from the very start of the hospital stay
Glasgow Coma Scale: why it is still used
Understand how the level of consciousness is assessed in neurological patients, the scoring structure, its clinical applications and its continuing relevance for triage, monitoring and decision-making in hospital emergencies
What are the types of hospital accreditation and the ONA levels?
Get to know the most common main certification methodologies in Brazil (ONA, Qmentum and Joint Commission) and the three levels, and understand how each one affects patient safety and the institution’s data governance
Rivio Talent: Lucas Santos, Software AI Engineer
A Computer Science graduate of the Federal University of Itajubá (Unifei), in Minas Gerais, Lucas Santos has built a fast-moving career in software engineering, working on projects in…
What defines an adverse event in healthcare?
Understand the technical definitions of incidents and adverse events according to Anvisa, see the latest 2023 data on care failures in Brazil and discover how data governance and AI mitigate hospital risks and costs.
The ANS DUT: a key requirement for using a health plan
Understand how the Utilization Guideline (DUT) defines coverage of tests and therapies in private healthcare, why clinical documentation is the key to avoiding refusals and how to ensure your hospital’s regulatory compliance.
FHIR: get to know this international interoperability standard
Discover how Fast Healthcare Interoperability Resources supports health data exchange, connecting care to billing to reduce errors, optimize auditing and ensure the sustainability of the revenue cycle.
Care coordination in the SUS and in private healthcare
Understand the paths to integrating the patient journey to improve clinical outcomes, reduce waste and ensure the financial sustainability of the institution or the public health system.
Types of hospital audit: concept and day-to-day practice
Understand how to structure clinical, administrative and financial controls along the patient journey to reduce denials, increase revenue predictability and strengthen hospital governance through this strategic resource.
Nurse navigator: why this profession matters
Understand the key role this position plays in organizing the patient journey, reducing care waste and strengthening the revenue cycle in high-complexity settings.
Care management: a sustainable strategy for healthcare
Learn how to structure a care management program that reduces readmissions, controls care costs and strengthens the revenue cycle through risk stratification and data intelligence.
Gene therapy: from science to high-complexity management
Learn how genetic modification is transforming the treatment of rare diseases and cancers, and discover ways to integrate this innovation into the sustainability of the hospital cycle.
Types of hospitalization in health plans: what the ANS requires
Understand the types of hospitalization covered by health plans, the differences between outpatient and inpatient segmentation, waiting periods and ANS rules to ensure adequate coverage and avoid unexpected costs.
Hospital Admission Authorization (AIH): know the rules
Learn the rules, authorization steps, mandatory fields and impact on hospital billing. Understand how filling in this documentation correctly helps reduce denials, strengthen auditing and protect the revenue cycle.
Test management: how to avoid wasting resources
Learn how ordering, managing and controlling clinical tests can be strengthened through data integration, value-based protocols and artificial intelligence.
What does high complexity mean in healthcare?
Understand the impact of this concept on hospital management. Find out how to balance the use of cutting-edge technologies, patient safety and financial sustainability through intelligent, strategic auditing.
IDSS 2025: private healthcare improves its average score
See the results of the Supplementary Health Performance Index (IDSS) 2025, base year 2024. Learn how accreditation influences scores, see the data by segment and understand how this index helps strengthen the sector.
Rivio Talent: Brunna Dopper, AI audit deployment
Born in the city of São Paulo to a father from Rio Grande do Sul and a mother from Minas Gerais, Brunna Dopper is a nurse auditor and deployment analyst.
SIGPAT table: get to know this management tool
Understand how this system manages the SUS Unified Table and affects hospital billing. Find out the differences between the systems, why constant updates matter and how technology can reduce billing errors.
What RN 507 says and how it affects health plans
Understand the pillars of ANS Normative Resolution 507, the criteria for obtaining accreditation, the classification levels and how regulatory incentives affect the financial health of health plan operators.
Funds bet on the Rivio solution for hospital management
Monashees, Valor Capital Group (NY), Endeavor and Positive Ventures believe in the transformation of Brazilian healthcare proposed by Rivio. The rounds represent one of the largest investments ever made in a company less than a year old in this industry.
Hospital infections (HAIs): how technology reduces risks
Understand what HAIs are, their multimillion financial impact and how intelligent auditing, combined with advanced technology, helps reduce hospital infections and costs in the revenue cycle.
Hospital auditing: areas of practice and the auditor’s profile
Learn about the main areas of hospital auditing, the most valued skills and how technology is changing the career.
Meu SUS Digital: technological transformation in public healthcare
Learn what Meu SUS Digital is, how to access the platform and which services are available to make your healthcare journey in the public system easier.
Outpatient management: how to organize care outside the hospital
Outpatient management involves organizing people, processes and data outside the hospital. See how to gain efficiency, cut costs and improve care.
Value-Based Healthcare: how do you measure success in healthcare?
Understand what Value-Based Healthcare is, how Michael Porter formulated the concept and why value in healthcare came to be measured by outcomes and costs.
SUS principles: what they are and how they apply
Learn about the principles of SUS, their foundations, the differences between universality, comprehensiveness and equity, and how they apply to public health management.
Rivio Talent: Artur Giovanella, product manager
With degrees in Nursing and in Information Systems, both from the Catholic University of Santa Catarina…
Digital prescriptions: what they are and how to validate them
Understand the rules of the CFM (Federal Council of Medicine) for digital prescriptions, when a qualified electronic signature is required and how to validate prescriptions.
Hospital DRP: a logistics approach explained
Understand what hospital DRP is and how this concept relates to good healthcare management practices.
PBM: a complete guide to paying less at the pharmacy
A PBM is a program that offers discounts on medications. Understand how it works, the main PBMs in Brazil and how to pay less at the pharmacy.
SNGPC: why this control system matters
Understand what the SNGPC is, how medication control works and the impact of the return of mandatory transmission set by Anvisa (Brazil’s National Health Surveillance Agency).
Digitalization in the hospital sector: impacts on healthcare
Data shows how digitalization in hospitals and clinics improves management efficiency, quality of care and data-driven decisions.
AI agents in healthcare: a revolution in hospital management
Artificial intelligence applied to hospital management has entered a new phase. After years of using generic models for one-off analyses, the industry is starting to adopt more mature architectures…
How much a physician earns in 2026
Find out how much a physician earns in 2026, which factors can raise salaries in the profession and what the main regional differences are.
Enamed: results of the exam that assesses medical education
See the Enamed results released in January 2026, which reveal the performance of medical programs in Brazil.
Care pathways: a strategy for integrating care
Learn about care pathways in healthcare, according to the rules and regulations, and the role each one plays in strengthening comprehensive health.
Copayment in health plans: what it is and how it works
Understand what copayment in health plans is, how it is calculated, what the ANS limits are and when this model is worth it for the plan member.
Rivio Talent: Vitoria Novaes, Product Manager
Vitoria Novaes works as a Product Manager at Rivio, where she turns complex operational challenges in the healthcare sector into technology solutions. Born in Rio de Janeiro…
Integrative medicine: concept, application and challenges
Integrative medicine combines conventional and complementary practices, with potential benefits, mixed evidence and limits that call for careful use.
Electronic health record (EHR): why it matters
Understand what an electronic health record is, the legal requirements, how it differs from the paper record and its impact on auditing and billing.
National Health Fund: the main rules
Understand what Brazil’s National Health Fund is, its goals, the rules for calculating resources, funding blocks, transfers and reimbursement to the SUS (Brazil’s public health system).
PROFIMED: meet the “bar exam” for medicine
Understand what PROFIMED is, how it differs from Enamed and Revalida, and the rationale behind the bill that creates the exam.
Rivio Talent: Pedro Orii, AI engineer
Meet Pedro Orii Antonacio and his path at Rivio, a company that values people who combine technical knowledge with problem-solving drive and creativity.
Digital health: the current Brazilian landscape
Understand the concept of digital health in Brazil, its main challenges and the data from the SDB Indicators Dashboard on telehealth between 2020 and 2025.
Best public hospitals in Brazil: the 2026 ranking
See the list of the 100 best public hospitals in the country, where they are located, their main characteristics and the main challenges they face.
NPS in hospitals: how to measure the patient experience
See how NPS in hospitals supports management decisions, identifies failures in the patient journey and contributes to the hospital’s financial sustainability.
Nurse auditor: a strategic role in healthcare management
Understand what a nurse auditor is, what they do, how much they earn, their activities, Cofen regulation and CBO code 2235-10.
Healthcare Innovation Show 2026: what to expect
Healthcare Innovation Show 2026 brings together managers, executives and healthtechs to discuss innovation, technology and the future of digital health.
Care protocols: the foundation of healthcare
Understand what care protocols are, why they are essential in hospital management and how they directly affect patient safety.
What a TUSS code is and how to identify it
Understand what a TUSS code is, how it works in private healthcare and why it matters for hospital billing and auditing.
Turnaround time: why time matters in healthcare
Understand what turnaround time is, why it is so important, how it affects patients and managers and how it can be reduced with processes and technology.
Remote monitoring in healthcare: continuous, connected care
Understand what remote monitoring in healthcare is, how it works, its applications in the SUS, its benefits and the role of technology in continuous care.
How healthtechs are transforming healthcare
Understand what healthtechs are, what they are for and how these startups use technology to transform the management, care and sustainability of healthcare.
Accredited hospitals: excellence in healthcare services
Find out what accredited hospitals are, how accreditation works, how many hospitals are accredited in Brazil and its impact on hospital management.
6 challenges biosimilars bring to hospital management
Understand what biosimilar medications are, how they are developed, how safe they are, their economic impact and what sets them apart from generics
Technology in healthcare: the innovation that saves lives
Technology in healthcare has always evolved alongside medical practice. What was once cutting-edge technology (such as the stethoscope in the 19th century or the X-ray in the early 20th century) is now part of the…
ANS: what it is and how health plans are regulated
Understand what ANS is, its origins, its responsibilities, its importance for private healthcare and the new ANS rules for health plans.
The impact of denials on the hospital revenue cycle
Discover how denials undermine a hospital’s financial health and how strategic management can optimize the revenue cycle.
Increases and cutbacks in family health plans
Understand the percentage caps set by the regulator for adjusting individual and family plan premiums in the current cycle, as well as the differences in negotiations for employer-sponsored and affinity group contracts
What is the urgent or emergency surcharge?
Learn when to apply the 30% surcharge on physician fees under the CBHPM. This article explains the rules for night hours, weekends and holidays, as well as how to fill in the TISS standard correctly to avoid denials
Why concurrent audit matters for hospitals
Understand how continuous review during the hospital stay optimizes the revenue cycle and identifies care failures and billing inconsistencies in real time to reduce denials and raise the quality of patient care
The new ANS denials dashboard: what is new
Meet the regulator’s new transparency tool, which consolidates metrics on payment times and financial refusal rates to improve the monitoring of cash flow between hospitals and payers
ANS 2025 price adjustment: the main updates
See the 6.06% cap set for individual and family contracts in the 2025/2026 cycle. This article explains the difference for the group segment and market projections in light of changes in healthcare expenses
Four hospital management events in 2026
Discover four hospital management events in 2026 that bring together healthcare leaders around innovation, technology and governance for hospitals and payers.
Why bed management matters for the hospital
Understand what hospital bed management is, its challenges for the healthcare industry and how technology optimizes occupancy and clinical outcomes.
Feira Hospitalar 2026: innovation and business in healthcare
Find out what to expect from Feira Hospitalar 2026, Latin America’s largest healthcare event, with a focus on innovation, management and hospital technology.
Healthcare under reconstruction: lessons from Conahp 2025
Conahp 2025 brought important reflections on integration, trust, data, transparency, AI and innovation that are shaping the future of healthcare in Brazil.
Revalida: the medical diploma revalidation exam
Learn how Revalida works, the exam that assesses physicians trained abroad and validates their diplomas so they can practice safely and legally in Brazil.
Get to know the International Patient Safety Goals
Get to know the six International Patient Safety Goals, how they are applied and how they reduce care risks in the hospital setting
Top medical congresses and healthcare events of 2026
Discover 8 medical congresses in 2026 in Brazil and abroad that already have confirmed dates, ideal for staying up to date, networking and new experiences.
Telemedicine: an X-ray of a new model of care
Understand the concept of telemedicine, how it works, its models, requirements and impact on healthcare management. See its evolution, benefits and challenges in Brazil.
ABSS: meet the association of health startups and healthtechs
Understand ABSS’s role in advancing health startups, its history, challenges and impact on the digital transformation of the Brazilian healthcare sector.
Health 4.0: how technology became an ally of hospitals
Understand how Health 4.0 digitizes processes, integrates data and improves management, care and clinical outcomes, paving the way for Health 5.0.
How AI agents are transforming hospital management
Understand how Rivio’s innovative AI agent architecture is transforming hospital management in Brazil, saving healthcare resources and saving more lives
What is SADT and what is its role in hospital efficiency
Understand what SADT is and why it is essential to quality of care, operational efficiency and the financial sustainability of hospitals.
What the London Protocol is and why it improves healthcare
Understand the London Protocol and how it helps investigate adverse events, increase safety and improve efficiency in healthcare institutions.
MSL (Medical Science Liaison): what it is and why it is essential in healthcare
Understand how the MSL helps integrate the pharmaceutical industry, scientific research and medical teams, freeing up time for patient care.
FIFO, FEFO and LIFO: the golden acronyms of healthcare logistics
Understand what FIFO, FEFO and LIFO mean: acronyms that refer to inventory management methods for avoiding waste in healthcare.
RPA: what it is and why it revolutionized hospital management
Learn how Robotic Process Automation (RPA) gave rise to intelligent AI-based solutions, transforming the efficiency of hospital management.
Hospital financial management: a systemic view makes the difference
Learn how efficient hospital financial management depends on a systemic view and understand how AI optimizes processes and improves results.
OpenEvidence: why an “AI mindset” matters
Discover how the startup OpenEvidence is transforming the routine of physicians and hospitals with AI and how it can free up more time for patient care.
Unified electronic medical record: what changes in healthcare
Understand how SUS and the private sector are building a unified, secure electronic medical record, with interoperability and digital governance.
What is the ICD and how does it work?
Learn how the International Classification of Diseases, which is divided into chapters, is structured, and how its alphanumeric codes are defined.
How the logic of the Nobel in Economics lights the way
Learn how and why the technological revolution will only thrive when the healthcare sector breaks with the incentives of the past and embraces creative destruction.
The patient journey and hospital management
Building patient loyalty may sound strange, but it is a strategy. Learn how satisfaction, NPS and AI make the hospital journey more human, efficient and memorable.
Healthcare managers and attending events
Find out why events such as HospitalMed, Conahp and Healthcare Innovation Show help managers stay up to date on technology and innovation in the healthcare industry
Brazilian hospitals as an example of quality and efficiency
Gustavo Meirelles, Afya’s Medical VP, healthcare innovation specialist and Rivio advisor, shows in this article that several Brazilian hospitals are among the best in the world and points out how the country can increase that number
How AI is shaping medical innovation champions
Medical innovation with AI: see how Brazilian projects are transforming diagnosis, monitoring and hospital management with artificial intelligence.
Four tips for innovating in hospital management
Innovative hospital managers create and nurture a culture of change, learning and efficiency. Learn how to develop this mindset.
Doctors need care too
The heroes in white coats are falling ill because of their workload, dehumanization and the forced distance between doctor and patient.
The waste healthcare (still) tolerates
See how a routine exam made plain some of the pain points of Brazilian healthcare that are not always noticeable and that can be solved with AI.
Is it valid to charge a double fee for a patient in a private room?
Learn when physician fees can be charged double for patients in private rooms, according to CBHPM rules.
Why we need managers who master AI
Bringing artificial intelligence into business administration education has become imperative to prepare managers capable of leading complex organizations, especially hospitals, in a landscape driven by data, automation and technology governance
How the CMED Table supports hospitals’ financial health
Understand what the CMED Table is, why it matters in the hospital revenue cycle and how Rivio uses AI to optimize financial management.
Meet Rivio, the most efficient AI in Brazilian healthcare
Rivio is the only company in Brazil that offers a contractual payment guarantee: its AI audits 100% of claims, eliminates denials and automates billing from start to finish, taking care of the hospital’s financial health so the hospital can take care of lives
Brasíndice and SIMPRO tables: differences and uses
Understand the differences between the Brasíndice and SIMPRO tables and learn how to use each one in hospital billing. A complete guide for managers.
How do you calculate procedures performed by video technique?
Procedures by video technique: see when to apply the rules, how to record them in billing and which codes and tiers the CBHPM sets for these cases.
ANS monitoring: what nurse auditors need to know
ANS monitoring: see the role of the nurse auditor in tracking indicators, regulatory compliance and quality of care.
Endoscopy and colonoscopy on the same day: are two fees paid?
Understand how equipment fees are charged when an endoscopy and a colonoscopy are performed on the same day, according to CBHPM rules.
What are paper and electronic audit cover sheets?
Understand what paper and electronic audit cover sheets are and how each one is used in hospital claims auditing.
Health plan cancellation for nonpayment
The ANS has updated the rules for canceling health plans for nonpayment. Understand what changes and where plan members’ rights stand
UCO reduction for multiple imaging tests
Understand the CBHPM regulatory changes that removed automatic discounts on the operational cost unit for sequential diagnostic procedures, and why reviewing individual contracts matters to avoid financial losses
Health plans for R$ 100? Understanding the ANS proposal
Learn about the proposal for lower-premium plans focused on outpatient visits and tests, which aims to expand access to primary care while sparking debate over the exclusion of hospital stays and therapies
Payment for multiple births: how to calculate it
Understand the correct coding for the birth of twins and how multipliers apply to the care team’s fees depending on the delivery route, ensuring accurate billing for the care provided to each newborn
How to charge physician fees for ECMO?
Discover the right TUSS coding for extracorporeal membrane oxygenation and the payment components tied to the installation, maintenance and removal of this life support in the intensive care setting
How are hospital visits billed for a vaginal delivery?
Understand the CBHPM rules on paying for medical assessments in obstetric procedures and find out why the first day of the hospital stay follows different rules from those applied to elective surgical cases
How are procedures at the same site billed?
Understand the CBHPM guidelines for paying for exams performed twice in the same encounter and learn to apply the 70% rate on the operating cost of additional items to ensure compliance in hospital audits
What are the billing rules for bedside procedures?
Understand the CBHPM conditions that allow physician fees to be valued at double when care takes place in superior accommodations or intensive care units by the patient’s choice
How to bill a CT scan covering several segments?
Understand how percentages are applied to imaging tests covering multiple areas of the spine under the CBHPM, with a focus on the rules for operating costs and the valuation of radiological film to ensure accurate billing of complex cases
Document Submission in TISS 4: how it works
Learn about the binary attachment feature in XML messages that streamlines auditing and denial appeal processes, and see in detail the permitted formats and required fields that keep data traffic secure
How do you know which access route type is correct?
Discover the CBHPM valuation rules for procedures through single or multiple incisions and understand how the fifty or seventy percent additions to physician fees apply depending on the anatomical region addressed in surgery
Special-hours rules for elective care
Understand the CBHPM’s regulatory distinction that rules out applying extra rates to scheduled procedures, since the thirty percent bonus is restricted exclusively to cases of immediate care and critical situations
Rules for billing hospital visits after surgery
Understand the CBHPM rules on medical follow-up after procedures. This article details the ten-day coverage period included in the tier and the rules for billing visits and progress notes separately during a hospital stay
How do you identify one or more access routes?
Learn the CBHPM rules for valuing multiple interventional procedures. This post explains the percentage increases in physician fees according to the approach method used on different organs or structures
ANS RN 623: learn about its direct impact on management
Understand the guidelines that redefine service to health plan members, set strict deadlines for care responses and require greater traceability in payers’ ombudsman and audit protocols
How to fill in the reduction or surcharge factor
Learn how to correctly fill in the TISS fields that apply rates to the value of procedures. This article explains how to use decimals and avoid common errors that lead to denials in settlements with health plans
What is the methodology for calculating tiers in the CBHPM?
Discover the scoring logic based on technical complexity and clinical risk that defines how medical procedures are paid. This guide details the classification criteria that ensure fairness in negotiations in the private healthcare sector
RN 465: what changed
Understand the updates to the rule that governs the list of covered procedures, including coverage of outpatient injectable therapies and expanded newborn screening tests, ensuring payers’ regulatory compliance
New mandatory procedures: ANS resolution
Normative Resolution 619 adds new technologies to the list of mandatory coverage, including diagnostic tests for tuberculosis and contraceptive implants, and requires immediate attention from hospital billing teams
New ICD table: main changes
Learn about the main changes to the WHO’s international classification of diseases, including the new digital structure, new chapters on sexual health and the technical debate over the codes related to the aging process
Nurse auditor: outlook and average salary
Understand the pay projections for 2025 and the career outlook in private healthcare, analyzing regional averages, the top of the pay scale and the impact of new technologies on how these professionals are valued in the national market
All about HME, HMEF and HEPA respiratory filters
Learn the differences between these essential devices for microbiological protection and humidity maintenance in mechanically ventilated patients, preventing contamination of the environment and of hospital equipment
TUSS table update: find out what changed
Understand the main changes to the Unified Terminology for Supplementary Health, including new codes and revisions to materials and medications, ensuring hospital billing compliance and avoiding operational denials
10 tips to improve hospital billing
Improve your institution’s financial health with 10 practical tips for hospital billing. Learn how to reduce denials and optimize processes with technology.
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