Hospital accreditation: what it is, ONA levels and why it matters

Hospital accreditation is a voluntary external evaluation process, carried out by accredited independent bodies, that verifies whether a healthcare institution meets pre-established quality and safety standards. Unlike mandatory inspections by Anvisa, for example, accreditation starts as an initiative of the hospital itself.

For hospitals that pursue certification, the process brings external recognition and helps reorganize internal management, standardize processes, reduce clinical variability and create the conditions for billing that is more solid and less subject to disputes.

How hospital accreditation works

Fewer than 9% of Brazilian hospitals hold any accreditation certificate. Out of 7,600 institutions registered in the National Registry of Health Establishments (CNES), only 667 have the seal. Although this number grows every year, a formal culture of quality is still far from universal in the industry.

The certificate is valid for a set period and must be renewed periodically. Accreditation is therefore a cycle of continuous improvement.

Main accreditation bodies in Brazil

ONA (National Accreditation Organization)

It is the national reference. With 425 certified hospitals, it is the body with the widest reach in the country, present in every region and type of management: 57% of ONA-accredited hospitals are private, 21% public and 19% philanthropic.

Joint Commission International (JCI)

One of the most recognized seals in the world, with standards developed in the United States and adopted in more than 100 countries. In Brazil, about 70 healthcare organizations hold JCI certification, mostly large private hospitals.

QGA (Quality Global Alliance)

An international accreditor with a growing presence in Brazil, especially among mid-sized hospitals looking for an internationally recognized certification with a process adapted to the local reality.

The three ONA accreditation levels

The ONA model organizes certification into three progressive levels, each with stricter requirements than the one before.

Level 1 — Accredited

The entry level certifies that the institution meets the basic requirements of safety and quality of care. The focus is on structure: how processes are organized, professional qualifications, infrastructure conditions and compliance with regulations. It is the starting point for hospitals beginning the accreditation journey.

Level 2 — Fully Accredited

The second level moves on to integration between processes. It is not enough for each department to work well in isolation: the institution must show that areas communicate with one another, that processes are traceable and that there is evidence of continuous improvement based on indicators. The hospital starts to be evaluated on the quality of its results, not just its structure.

Level 3 — Accredited with Excellence

ONA’s highest level certifies institutions that, in addition to meeting all the requirements of the previous levels, show systematic improvement cycles, evidence-based management and a culture of quality spread across every level of the organization. It is the benchmark for hospitals that want to be recognized as centers of excellence in Brazil.

How the accreditation process works

The process begins even before contact with the accreditor. The hospital needs to carry out an honest self-assessment, identify gaps against the required standards and put together an improvement plan. This preparation period can take from a few months to more than a year.

Once the self-assessment is complete, the hospital hires an accrediting institution certified by ONA, or JCI or QGA directly, depending on the chosen body. The accreditor carries out an evaluation visit, which includes interviews with professionals, facility inspections, medical record reviews and indicator checks.

At the end of the visit, the evaluators issue a report with the points of compliance and the nonconformities identified. If the institution meets the required standards, it receives the certificate, which is valid for two years for ONA. During that period, maintenance visits check whether the standards are being sustained.

Benefits of accreditation for the hospital

Quality of care

Standardized processes reduce clinical variability. When protocols are clear and followed systematically, outcomes improve and adverse events decrease.

Patient safety

Accreditation requires the hospital to have active mechanisms to identify and prevent risks: surgical checklists, hygiene protocols, barriers against medication errors. Evaluators check whether these mechanisms are in use.

Financial results

Accredited hospitals have more organized processes, more robust documentation and better-trained teams. That translates into less rework, a lower rate of technical denials and better-structured claims. Quality of care and quality of billing go hand in hand when processes are well defined.

Reputation

Certification is a clear signal to health plans, patients and partners that the hospital is committed to recognized standards. In contract negotiations with health plans, accredited hospitals tend to have more bargaining power.

Accreditation and the revenue cycle

An accredited hospital has clear advantages in the revenue cycle. Standardized processes produce more consistent documentation, and consistent documentation better supports charges. Complete medical records, traceable care records and compliance with payer requirements leave less room for disputes over clinical appropriateness or insufficient documentation.

But accreditation does not solve everything. The certificate attests that processes are structured, not that billing is being carried out correctly for each hospital stay. Coding errors, mismatches between diagnosis and procedures, and the lack of concurrent auditing keep generating denials even in accredited hospitals.

This is exactly where Rivio comes in. The AI platform reads medical records automatically, cross-checks care records against each payer’s rules and identifies inconsistencies before the claim is submitted. For accredited hospitals, this means making the most of the quality of processes already in place. For those still on the path to certification, it means protecting revenue while the accreditation journey moves forward.

Frequently asked questions about hospital accreditation

Is hospital accreditation mandatory in Brazil?

No. Accreditation is a voluntary process. No federal law requires hospitals to seek certification. The decision comes from the institution itself, driven by goals of quality, competitiveness or contractual requirements of certain health plans.

What is the difference between ONA and JCI?

ONA is the national reference body, with a methodology developed for the reality of the Brazilian healthcare system. JCI is an American body with international standards, recognized in more than 100 countries. Hospitals that serve foreign patients or seek international visibility tend to prefer JCI. For most Brazilian hospitals, ONA is the more suitable path.

How long does it take for a hospital to become accredited?

It depends on the level sought and the current maturity of processes. In general, preparation up to the first ONA certification takes 12 to 24 months. Hospitals that already have well-structured processes can move faster; those starting from scratch need more time to implement the necessary changes.