Blog
Hospital billing
44 articles on hospital billing on the Rivio blog.
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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.
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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.
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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.
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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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