Blog
Healthcare regulations
42 articles on healthcare regulations on the Rivio blog.
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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.
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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
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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.
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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
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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
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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
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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
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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
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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
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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.
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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
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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
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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.
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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
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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
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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
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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
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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
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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
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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
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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.
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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.
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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.
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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).
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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.
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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.
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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.
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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).
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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.
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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.
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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
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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.
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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
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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.
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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.
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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.
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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.
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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
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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
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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
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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
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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
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