What is a hospital's average collection period?
The average collection period is the average number of days between the moment the hospital bills for care and the moment the money reaches its account. For Brazilian hospitals that serve health plan members, it is measured on health plan (operadora) receivables, which make up most revenue: 76.47% of gross revenue at Anahp hospitals in 2025 [2].
It is the outcome metric for collections in the guide Revenue cycle KPIs. It shows that money is stuck, but not where. To find the cause, break it down by health plan and by segment of the claim's path, as shown in “The four segments of the collection period.”
How to calculate the average collection period
The accounting formula compares the receivables balance with the pace of billing:
Average collection period = (health plan receivables ÷ gross health plan revenue for the period) × number of days in the period
Illustrative example (hypothetical numbers). At the end of a 90-day quarter, a hospital has BRL 23.1 million in health plan receivables. Health plan revenue for the quarter was BRL 27 million. The result is 23.1 ÷ 27 × 90 = 77 days.
The same name covers different calculations. Before comparing numbers, check which one is being used:
| Method | How it is calculated | When to use it | Watch out |
|---|---|---|---|
| Accounting (balance) | Receivables ÷ revenue for the period × days | Monthly tracking, hospital-wide and by health plan | Swings with large end-of-month batches; use average balances or a 3-month window |
| Claim by claim | Average days between billing date (invoice or submission receipt) and payment date of each paid claim | Diagnosis by health plan and type of care | Only sees paid claims; long-stuck claims are left out |
| Average payment time (ANS) | Average days between the claim submission receipt and the last payment of each closed claim [6] | Comparing health plans on a public yardstick | Excludes open claims, member reimbursement and fixed-amount payments [6] |
| Anahp benchmark | Average of the metrics reported by member hospitals [1][2] | Industry trend | The quarterly reports do not publish the formula; the sample grew from 120 to 199 hospitals between 2023 and 2026 [3] |
Four decisions should be written into the metric's definition sheet:
- Numerator. Decide whether denied amounts under appeal stay in the balance. Keep the rule fixed and show the amount under appeal separately.
- Denominator. Gross health plan revenue for the same period, excluding self-pay and SUS (Brazil's public health system).
- Days. The actual days in the period (30, 31, 90, 365), not always 30.
- What is left out. Discharged patients' accounts not yet billed are not in receivables. They show up as discharged not final billed (DNFB): the collection period can look stable while a lot of money is stuck before billing.
What is the average collection period at Brazilian hospitals?
The main public benchmark is the Anahp Observatory (Observatório Anahp), which reports the average of hospitals that belong to Anahp: 194 members at the end of 2025, mostly large hospitals [2]. In 2025, their average collection period was 77.35 days, the highest in the series since 2021 [1][2].
See the numbers as a table
| Year | Average collection period (days) |
|---|---|
| 2021 | 68.56 |
| 2022 | 73.51 |
| 2023 | 76.38 |
| 2024 | 69.91 |
| 2025 | 77.35 |
| Anahp hospitals | 2021 | 2022 | 2023 | 2024 | 2025 |
|---|---|---|---|---|---|
| Average collection period (days) | 68.56 | 73.51 | 76.38 | 69.91 | 77.35 |
| Average supplier payment period (days) | 43.27 | 45.25 | 49.40 | 50.70 | 48.30 |
| Gap (days) | 25.29 | 28.26 | 26.98 | 19.21 | 29.05 |
Sources: [1] for 2021 to 2024; [2] for 2022 to 2025.
By quarter. Anahp's quarterly reports compare the same quarter of each year: 75.80 days (Q1 2023), 72.32 (2024), 74.31 (2025) and 73.84 (2026) [3]. Compare quarter with quarter, not with the full year. In 2026, Anahp changed the denominator of the supplier payment period to total expenses instead of gross revenue, so the 2026 gap between the two periods is not comparable with earlier years [3].
How to read these numbers:
- The 2021 value is not the 2024 value. The 68.56 days figure is from 2021; in 2024 the period was 69.91 days [1].
- It is an average of mostly large hospitals. Use the series as a trend and compare the hospital with itself.
- A different base. The 2026 Revenue Cycle Panorama by ZG Soluções, based on the company's client institutions, reported an average collection period of 53 days [7]. The base and method differ from Anahp's, so the numbers are not directly comparable.
For US readers: US days in A/R benchmarks reflect a different payer mix and contract structure, so they are not a direct comparison either. The guide Anahp Observatory explains the publication and its sample. All industry figures are on the Industry data page.
The four segments of the collection period: what the hospital controls and what the health plan controls
The collection period adds up four segments, each with its own owner. Measuring only the total does not show whether the delay starts inside the hospital or at the health plan.
| Segment | Starts and ends | Who controls it | Metric |
|---|---|---|---|
| 1. Before billing | From discharge to claim submission | Hospital | Discharge-to-bill time; DNFB |
| 2. Submission and acceptance | From submission to the receipt for an accepted batch | Hospital (file quality) | Batch rejection rate; returned claims |
| 3. Review and payment | From receipt to payment of the accepted amount | Health plan, within the contract term | Actual vs. contract payment term, by health plan |
| 4. Denial and appeal | From the denial to payment of the overturned amount | Both sides | Denial resolution time; overturn rate |
The accounting formula starts counting at the invoice, so it mainly measures segments 2 to 4; segment 1 shows up in DNFB. The full claim path is in the guide Hospital revenue cycle.
What does Brazilian law say about the health plan's payment term?
No law or ANS rule sets a maximum payment term: the term is whatever the contract between hospital and health plan says. Law 9,656/1998 (Lei 9.656/1998, the Health Plans Law), in article 17-A added by Law 13,003/2014, requires a written contract that sets the terms and procedures for billing and paying for services [4].
RN 503/2022 (Resolução Normativa 503/2022, ANS Normative Resolution on contracts between health plans and providers) details the requirement [5]:
- Art. 4, II, and art. 13: billing and payment terms and procedures must be spelled out in the contract.
- Art. 14, II: the contract sets the deadlines to contest a denial (claim denial), for the health plan to respond, and to pay overturned amounts. The deadline to contest equals the deadline to respond.
- Art. 17: the contract sets penalties for both parties for breach of obligations.
In 2026, ANS put out for public consultation (CP 170/2026) a draft rule that consolidates the contract rules. It proposes payment of the undisputed amount, the part of the claim that is not in dispute. As of October 17, 2026, the final rule had not been published, and the proposal is not in force [8].
The contract clauses are covered in the guide RN 503 payer contract, and collecting on late payments in the guide Late payer payments.
Internal levers: what the hospital can reduce on its own
Internal levers work on segments 1, 2 and 4, which depend on the hospital's own process and need no negotiation.
| Lever | Effect on the collection period | How to measure |
|---|---|---|
| Close the account earlier, with interim billing for long stays | Shortens the segment before billing | Discharge-to-bill time, by unit |
| Pre-audit before submission | Fewer denials, less money waiting on appeals | Initial denial rate; first-pass acceptance |
| Validate the TISS file before submission | Fewer rejected and resubmitted batches | Batch rejection rate, by health plan |
| Submit on each health plan's calendar | Avoids missing the cutoff date and waiting for the next cycle | Claims submitted after the cutoff |
| Appeal denials on time, prioritized by value | Shortens the denial and appeal segment | Denial resolution time; overturn rate |
| Reconcile each payment with the remittance statement | Quickly spots underpayments and missing payments | Unreconciled amount; aging by health plan |
A denied amount stays idle until the appeal is answered. At Anahp hospitals, the initial denial rate was 15.93% of amounts receivable from health plans in 2025 [2] (denominator as defined in [1]). The guide Claim denials covers the causes, and the guide Denial rate covers measurement.
External levers: contract, collections and ANS data
External levers work on segment 3, which depends on the health plan, and work best when the hospital's own numbers are already broken down by health plan.
- Clear terms and calendar in the contract. Payment term in days counted from the submission receipt, a cutoff date for submission and a payment term after a denial is overturned (RN 503/2022, arts. 13 and 14) [5].
- A written late-payment penalty. The contract must set penalties for breach of obligations [5]. Without a clause, being late costs the late party nothing.
- Systematic collections. Track actual vs. contract terms by health plan and follow up on the due date, with A/R aging by days past due.
- Public data at the negotiating table. The ANS Denial Indicators Dashboard (Painel de Indicadores de Glosa) shows, for each health plan, the average payment time and the initial and final denial rates [6]. Before renegotiating, compare each health plan's term with the others, using the most recent period published on the dashboard.
What a shorter collection period is worth
Each day in the collection period is idle capital: multiply daily health plan revenue by the days saved.
Illustrative example (hypothetical numbers). A hospital bills BRL 300,000 a day to health plans. Cutting the average collection period by 10 days frees about BRL 3 million in cash. At a cost of capital of 1% a month, that is about BRL 30,000 a month, or BRL 360,000 a year.
The calculation with the hospital's own borrowing rate is in the guide Cost of payer delays and in the Average collection period calculator.
What we see in operations
At Accrua, the average collection period is broken into segments before any action. When we read a hospital's history, we separate, by health plan, the time inside the hospital, from discharge to submission, from the time at the health plan, from filing to payment, and from the time spent in appeals. Each segment has its own owner and its own lever.
In the hospital's segment, Accrua OS reads the whole claim before submission, and agents handle XML validation, submission and deadline and status tracking. In the health plan's segment, claim-by-claim remittance reconciliation shows each health plan's actual payment time against the contractual one, which grounds both collection and negotiation.
When the collection period weighs on working capital, Receita Garantida puts the value of eligible production into the hospital's cash on the schedule it needs. That is possible because we run the cycle claim by claim and read risk by health plan, plan and claim type. Accrua takes on the risk of eligible denials: the hospital does not pay money back later.
Where to start
- Write down the formula in the metric's definition sheet: numerator, denominator, days and what is left out.
- Calculate the last 12 months by health plan, with the BRL amount next to the days.
- Separate the four segments and also measure discharge-to-bill time and DNFB.
- Compare actual and contract terms for each health plan and list the ones in breach.
- Bring the numbers to negotiations and to the monthly revenue committee, with the ANS average payment time as an external yardstick.