Blog/ E-books
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
- By
- Rivio, Editorial team
- Published
- Reading time
- 2 minutes
Stop losing time and resources to denials
Denials happen at every hospital. But the difference between those that lose revenue chronically and those that keep the problem under control lies in knowing exactly where errors happen and having a process to stop them before submission.
The Anahp Observatory recorded an increase in the accepted denial rate from 0.78% to 1.96% of gross revenue between 2021 and 2024. For a hospital with R$ 90 million in annual revenue, that difference means more than R$ 1 million more going down the drain every year.
Rivio produced this manual to give audit and billing teams what they need: clarity on the main causes of denials and a practical protocol to reduce how often they happen, in compliance with ANS regulations.
Rivio uses artificial intelligence to manage the entire hospital revenue cycle, from audit to payment. Our technology analyzes clinical records, cross-checks information against hospital claims, identifies and corrects denials, submits the XML and manages denial appeals, all automatically.
What you will learn
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The most frequent causes of denials and the stage of the cycle where they originate.
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How to correctly interpret payers’ denial codes and structure an appeal.
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Which fields of the TISS form concentrate the most filling errors and how to avoid them.
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How to make sure clinical documentation supports every charge before submission.
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What ANS regulations establish about deadlines, appeals and payer obligations.
The problem
Most denials reach the billing department as a surprise. In practice, they were produced days or weeks earlier: at patient registration, in the authorization request, in the care record, in the entry of a medication.
When the problem only shows up after submission, the cost has already doubled: there is the denied amount and there is the team’s time to appeal it. And not every appeal succeeds.
An anti-denial manual moves control to before the problem, turning reactive auditing into a preventive process.
Frequently asked questions
Is the material free?
Yes. Fill in the form and the download is available immediately.
Who is this manual for?
Medical auditors, billing specialists and hospital billing managers who deal with denials every day.
Do I need to be a Rivio client?
No. The material is open to any professional in the industry.
Does this manual replace knowledge of the CBHPM and the TISS standard?
The manual assumes the reader already knows the basics. The focus is practical application: where to make fewer mistakes, how to appeal better and how to build more robust processes.
