If you are one of the physicians who report to the Régie de l'assurance maladie du Québec (RAMQ), you should know what your medical billing options are, so that you can choose the method that best suits your needs.
To help you make an informed choice, PetalMD has compiled a detailed description of each of the four available options:
1. Manage your billing yourself with a digital solution
2. Manually send your payment requests to a billing agency
3. Entrust your billing to your department or clinic’s administration
4. Combine the use of a digital solution with the services of medical billing experts
1. Manage All Your Billing Yourself with a Digital Solution
With the advent of digital technologies, many physicians have chosen to manage their billing themselves with specialized software. However, by choosing this option, you are responsible for transmitting your payment claims yourself and for managing the follow-up directly with the RAMQ. For example, if you are faced with a payment refusal, you must find and correct the error yourself.
Not all billing solutions are created equal, especially in terms of features. If you start comparing them, you will find major differences from one system to another. Don’t rely only on the price; make sure that your chosen system meets your needs. For example, some software does not detect data entry errors, nor do they account for billing differences between a service rendered in a government institution versus a private one.
2. Manually Send Your Payment Requests to a Billing Agency
If you choose the services of a conventional billing agency, you will need to manually note your payment claim, for example, using paper (castonguettes), and then physically transmit these documents to your billing agency. The person responsible for your medical billing will then have to re-enter this information into a computer system and send it to the RAMQ. He or she will also be responsible for managing your account statements and verifying the amounts billed versus the amounts paid, etc.
If you choose this option, it is important to find a billing agency that will handle your RAMQ billing properly, since they will be responsible for the accuracy of your remuneration.
Here are some questions to ask yourself when choosing a billing agency:
- Does the staff at the agency have enough experience in medical billing for your discipline?
Make sure you select an agency with employees that have sufficient experience in your medical specialty, since they will need in-depth knowledge of all the medical billing particularities specific to your discipline. They should be able to provide you with optimal remuneration that corresponds to the amounts you are entitled to.
- Does the software used by the agency include an automatic validation system?
Double entry of information – first entered on paper by the doctor, then again by the agency in a digital system – involves the risk of transcription errors. Therefore, it is relevant to check whether the digital tool used by the agency includes an automatic error recognition system, which will allow the information entered to be validated as it is entered.
- Does the agency give you access to your billing information through a Web portal?
Some agencies offer access to a secure Web and/or mobile interface, allowing you to consult your payment history, account statements, invoiced items, expected amounts, etc.
3. Entrust Your Billing to Your Department or Clinic’s Administration
Some healthcare facilities allow physicians to take advantage of in-house medical billing services, that is: those provided by the facility's administrative staff. This option is often an affordable one, but it also comes with some risks.
First, it's important to keep in mind that RAMQ billing is a complex universe that changes a lot from one medical specialty to another. People who are highly competent in their normal administrative tasks do not necessarily have all the knowledge required to ensure the compliance of your payment requests with RAMQ standards. In addition, they might not be able to guarantee the optimization of your income based on the medical services you provide or your collective agreements.
Before choosing this option, we encourage you to read and negotiate your employment contract carefully. Remember that no one can force you to entrust your billing to a member of the health facility staff.
4. Combine the Use of a Digital Solution with the Services of Medical Billing Experts
This billing option, which is increasingly popular with physicians, represents a hybrid service between billing agencies and autonomous management. The physician first enters his or her payment claims into a specialized software rather than on paper, then everything else is taken care of by the agency. A team of RAMQ billing advisers will check the conformity of the information entered by the doctor and analyze the payment requests in detail before they are sent to the RAMQ.
Not all billing agencies offer this type of hybrid service in Quebec though this option has several advantages as it:
- Reduces the risk of transcription errors, since information is entered only once
- Requires no obligation to physically transport paper documents to a billing agency
- Reduces the risk of losing confidential paper documents
- Demands less administrative effort from the physician, since data is entered quickly
New Physicians: Which Option to Choose?
For new doctors, RAMQ billing generally appears to be an extremely complex world. For this reason, new physicians often opt for whatever billing option their colleagues are using, mistakenly believing that all billing agencies are created equal and that it's easiest to do so. However, the needs of doctors vary greatly depending on the physician and their medical specialty.
At the beginning of your medical practice, you should be well supported regarding medical billing. Choosing an option with support will save you a lot of headaches and will probably help you avoid complications like payment refusals and loss of income. Whatever you choose to invoice to RAMQ, don't forget that you can change your methods at any time during your career. Periodically you should reevaluate your options to determine if they are still suited to your needs and actual practice, your income depends on it!