Long hospital billing times: how to reduce them

The interval between the patient’s discharge and receipt of payment from the payer is one of the biggest financial challenges for Brazilian hospitals. According to the Anahp Observatory 2025 (National Association of Private Hospitals), the average time to payment for member hospitals was 77.35 days in 2024, a historically high and rising level.

This time is not determined by a single factor. It results from the accumulation of failures at different stages of the revenue cycle: poorly structured internal billing processes, weak contract management with payers and a high incidence of denials that add weeks to the payment cycle.

The role of the revenue cycle in time to payment

The clock on time to payment starts at the patient’s discharge, but its causes build up long before that. The hospital revenue cycle covers every stage between scheduling care and receiving payment: eligibility verification, procedure authorization, care records, billing, internal audit, claim submission and, when necessary, a denial appeal.

Each of these stages has a minimum operational time and an additional time generated by failures. An authorization requested late delays the start of care. An incomplete medical record when the claim is closed delays billing. A denial after submission adds 30 to 90 days to the cycle. The total time to payment is the sum of all these delays accumulated throughout the process.

Inefficiencies in the internal billing process

The stage the hospital can control most is the internal process of closing and submitting the claim. Even so, that is where many of the delays are concentrated.

Claims held up by pending documentation are the most frequent problem. A report that was not attached, an unsigned prescription or a material without an invoice prevents the claim from being closed and can leave it sitting for days or weeks before anyone spots the issue. In hospitals without systematic control of each claim’s status, these pending items pile up without raising any alert.

Keeping master data for procedures, materials and medications up to date is another point of risk. Outdated tables generate incorrect codes in billing, which result in automatic rejection by the payer or a technical denial. Correcting a code after submission requires an appeal and delays payment by weeks.

The lack of integration between the care and administrative teams also contributes. Information generated in care, such as prescriptions, physician progress notes and materials records, needs to reach billing completely and on time. When this integration is manual or fragmented, billing becomes dependent on information that arrives late.

Contract management and payer deadlines

Each payer has specific contractual rules: the deadline for submitting the claim after discharge, the transmission channel, the file format and the mandatory documentation for each type of procedure. Hospitals that do not have these deadlines centralized and visible to the billing team often miss submission windows, which forces resubmission or makes billing impossible.

The payer’s contractual payment term, after the claim is received and validated, also varies. Poorly negotiated contracts, or contracts that have not been reviewed in years, may have unfavorable terms that add to the internal processing time. Periodically reviewing contracts with a focus on payment terms is part of revenue cycle management, not just a legal matter.

Denials and the additional appeal cycle

When the payer denies an item on the claim, the hospital has to file an administrative appeal within the contractual deadline, prepare the supporting documentation and wait for the payer’s response, which can take another 30 to 90 days. Each denial appealed adds a full cycle to that claim’s time to payment.

The financial impact goes beyond the individual value of each denial. A high-value claim with multiple denials can have its payment delayed by months, undermining the hospital’s cash flow while the appeal process unfolds. That is why preventing denials through concurrent audit and prospective audit has a direct impact on reducing the average time to payment, not just the denial rate.

How to reduce hospital billing time

Reducing time to payment requires action on three fronts at the same time.

The first is the quality of the internal billing process. Defining clear responsibilities for each stage, tracking the status of each claim from discharge and clearing pending documentation at closing reduces internal processing time before submission. The hospital billing checklist is the practical tool for this verification.

The second is active management of contracts with payers. Knowing each health plan’s submission and payment deadlines, monitoring compliance with them and renegotiating unfavorable terms are actions with a direct impact on the average time to payment.

The third is reducing the denial rate. Every denial avoided is one appeal cycle eliminated. Hospitals that invest in structured internal auditing, with systematic verification before submission, reduce the volume of denials and the total time between discharge and payment.

A long time to payment is a permanent financial cost

Time to payment is not just an operational indicator. It determines the hospital’s cash flow, its ability to meet commitments to suppliers and staff and the margin available for investment. Hospitals with a long average time to payment need more working capital to operate, which increases the financial cost of the operation.

Rivio reduces time to payment by automating the audit of 100% of hospital claims before submission, eliminating avoidable denials and ensuring that claims reach payers complete and within the contractual deadline, with billing specialists supervising every stage.

Frequently asked questions about hospital billing times

Why does hospital billing take so long?

The time results from the sum of delays at different stages of the revenue cycle: internal closing of the claim, submission within each payer’s contractual deadlines and, when there is a denial, the additional cycle of appeal and response. Each stage with a failure adds days or weeks to the total time to payment.

What is the average time to payment for Brazilian hospitals?

According to the Anahp Observatory 2025, the average time to payment for member hospitals was 77.35 days in 2024. In large hospital networks, the number is even higher: a BTG Pactual report found 112.5 days in 2023, an increase of 19% compared with 2018.

How do denials affect time to payment?

Each denial appealed adds a new cycle to the time to payment: the hospital prepares the appeal, submits it within the contractual deadline and waits for the payer’s response, which can take an additional 30 to 90 days. Reducing denials is therefore one of the most effective ways to reduce the average time to payment.

What can the hospital do to reduce billing time?

The main levers are: structuring the internal claim-closing process so nothing is left pending, knowing and monitoring each payer’s contractual deadlines and reducing the denial rate through internal auditing before submission. The three fronts act at different stages of the cycle and have a cumulative impact on the total time.