In an article published in Medicina S/A, Eduardo Agostini, Business Development Director at Planisa, describes what he calls the financial squeeze on Brazilian private hospitals: care costs rising at double-digit rates, rigid revenue and constant pressure on cash.
The diagnosis is accurate and the numbers are harsh. But one point in the article deserves special attention from anyone running a hospital: a significant part of the squeeze isn't in costs. It is in revenue the hospital has already generated, already billed and not yet received.
Source: data cited by Eduardo Agostini (Planisa) in Medicina S/A, based on Anahp, IESS and Planisa.
It's not just cost: it's money stuck
The most revealing figure in the article is the gap between the initial denial rate, which reached 17% in early 2025, and the final denial rate, around 2%. In other words, most of what the payer denies ends up being paid, but only after months of back-and-forth. Throughout that time, the money sits on the payer's side, while the hospital keeps paying staff, supplies and vendors.
Add an average collection period of 73 to 79 days, versus 46 to 48 days to pay suppliers, and the result is a working capital hole of about a month. In practice, the hospital finances the payer with its own cash, and covers the difference with expensive credit or by postponing investment.
Why the revenue cycle became so hard to run
Between contract negotiation and money in the bank, revenue goes through ten stages: contract, registration, authorization, care delivery and charge entry, audit, pre-billing, closing and submission, denial appeal, collection and payment. Each payer has its own rules, tables that change and requirements that pile up. One weak link is enough for the bill to come back.
Most hospitals still run this cycle with spreadsheets, manual checks and overloaded teams that prioritize the urgent and miss the patterns that explain most denials. The cost of this complexity doesn't show up on a line of the balance sheet. It shows up as recurring denials, revenue that was never charged and an aging report that keeps growing.
How Accrua helps hospitals recover what is theirs
Accrua runs the revenue cycle end to end, with AI technology, a specialized team and accountability for results. We work on three fronts:
Prevent denials before the bill goes out
Each payer's contract rules applied from registration, authorization and charge entry. AI agents review 100% of bills before submission, and the auditor only steps in on flagged exceptions, with context and a recommendation.
Recover money stuck with payers
Denial appeals with an automated workflow, backed by each payer's acceptance history, and collections prioritized by delay pattern. What already belongs to the hospital returns to its cash faster.
Bring forward days of cash
Automatic reconciliation and monitoring of each payer's payment behavior reduce the average collection period. With the cycle run by Accrua, the Accrua FIDC structures working capital priced on the receivable's real risk.
So the hospital can get back to doing what it does best
The Medicina S/A article ends by calling for systemic answers: smart contracts, price adjustments more aligned with medical inflation and rigorous operational efficiency. We agree. Part of that answer depends on the industry as a whole. Another part is within every hospital's reach today: to stop losing revenue on the way from care delivery to cash.
Hospitals should not lose revenue because their infrastructure stopped evolving. Every real recovered from denials and every day of cash brought forward is breathing room to keep beds open, invest in the team and keep doing what the hospital does best: caring for lives.