Blog/ E-books
Guide to medical auditing and hospital billing
Getting hospital billing wrong is expensive, and this e-book shows how to get it right. Find the answers to 13 real billing and auditing questions, based on the CBHPM, the TISS standard and ANS rules
- By
- Rivio, Editorial team
- Published
- Reading time
- 2 minutes
Billing incorrectly means losing revenue; billing too much means creating a denial; billing at the wrong time means opening an appeal that could have been avoided.
In day-to-day hospital billing, the most costly questions are usually the most practical: when should you charge the scrub technician fee? Does colonoscopy with chromoscopy have its own code, or is it billed separately? Does the urgency add-on apply to surgery performed the next day?
Wrong answers to these questions translate into denials, disputes and revenue that is never received.
Download the free e-book with 13 real questions answered by Rivio specialists, based on the CBHPM, the TISS standard and the rules of the ANS (Brazil’s National Supplementary Health Agency).
What you will learn
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When and how to charge the surgical scrub technician fee, and why the procedure size does not determine it.
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The access route rules for cesarean section with tubal ligation, oophoroplasty and hysterectomy with adnexectomy.
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Which code to use for colonoscopy with chromoscopy (and why billing it separately leads to a denial).
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Under which conditions the 30% urgency add-on applies, and under which it does not.
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How to double the physician fee for private-room patients without breaking CBHPM rules.
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How to fill in fields 36, 37 and 38 of the TISS form when the procedure runs past midnight.
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Why the ICD code is not mandatory on the SADT form, based on an ANS decision.
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How to appeal denial NR 1708 (“no value for the surgical procedure”).
The problem behind each question
The CBHPM has hundreds of rules. The TISS standard is updated frequently. Each payer interprets the rules in its own way.
The result: billing and audit teams work with uncertainty at the edges of the process, exactly where denials are concentrated. A question not answered at the right time turns into a claim submitted incorrectly, then a denial received, then hours of rework to appeal it.
The Anahp Observatory recorded an increase in the accepted denial rate from 0.78% to 1.96% of gross revenue between 2021 and 2024. A significant part of this increase comes from avoidable coding and form‑filling errors.
The Rivio solution
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.
Frequently asked questions
Is the e‑book free?
Yes. Just fill in the form to access the download immediately.
Who is this material for?
Billing specialists, physician auditors and hospital billing managers who deal with the CBHPM, TISS and contracts with payers every day.
Do I need to be a Rivio client to download it?
No. The material is open and free to any professional in the industry.
