11 Medical billing terms Quebec physicians should know

Key takeaways

1. Understanding RAMQ billing terminology is essential for accurate compensation. Knowing core billing terms helps Quebec physicians submit claims correctly and ensure they’re paid fairly.
2. Different remuneration models affect how physicians are paid. Quebec physicians may be compensated through fee-for-service, mixed remuneration, or hourly medico-administrative rates depending on their activities and practice setting.
3. Billing details like time slots and context matter. RAMQ requires physicians to report specific work periods and contextual factors, which directly influence billing eligibility, rates, and claim approval.

Understanding key RAMQ billing terms—such as acts, remuneration by act, mixed remuneration, time slots, elements of context, dispensing sites and on-call availability—helps physicians submit claims accurately to meet billing requirements and limit the risk of rejected claims.

Medical billing in Quebec comes with its own distinct lexicon, so it’s no surprise many physicians, especially new ones, find it confusing.

RAMQ billing involves specialized terms, codes, and categories that directly influence how physicians are compensated for their services.

• A clear understanding of these terms supports billing accuracy, regulatory compliance, and fair compensation for every act performed.

Regardless of your care setting, mastering these definitions will limit claim rejections, minimize lost revenue, and allow smoother cross-team coordination.

To simplify your billing process, we’ve compiled a guide to 11 essential RAMQ billing terms every doctor should know:

1. Act
2. Mixed renumeration
3. On-call availability
4. Premium for remote locations
5. RAMQ time slots
6. Elements of context
7. Dispensing site
8. Reference site
9. Medico-administrative hourly rate and teaching activities
10. Remuneration by act
11. Professional reference 

1. Act

An act (acte) relates to a procedure or action performed by a physician. Each action is represented by a code, which corresponds to a specific rate. You can find these codes and rates in your RAMQ manual.

2. Mixed remuneration 

Mixed remuneration (rémunération mixte) combines two payment types:

• A reduced rate per billed act
• A fixed daily rate per half-day of practice

This system applies only in specific practice sectors and designated institutions, subject to departmental authorization.

Note: It is only valid between 7 a.m. and 5 p.m. on weekdays, excluding holidays.

3. On-call availability 

On-call availability (garde en disponibilité) refers to being available to respond to patient needs without necessarily being on site. Understanding your on-call category is vital to ensuring accurate RAMQ billing and fair compensation.

Quebec recognizes three types:

1. Local on-call availability (garde locale): Specialized physician available within a healthcare facility.
2. Support on-call availability (garde en support): A second physician, in the same specialty, available to assist the primary on-call physician.
3. Multi-facility on-call availability (garde multi-établissements): A physician on call at one site but covering additional facilities.

4. Premium for remote locations  

This premium (majoration) rewards physicians working in regions with limited healthcare resources.

Different rates apply depending on territory and physician status. Temporary support or substitution work often qualifies for a minimum bonus.

Eligibility requirements:

• More than 50% of practice must occur in a remote territory.
• Physicians must file a Statement of Primary Territorial Practice – Diversified Compensation annually.

5. RAMQ Time Slots

RAMQ divides each day into specific time slots. Physicians must declare the slot or slots worked for proper compensation.

Standard time slots:

• Night: 12:00 a.m. – 7:00 a.m.
• Morning: 7:00 a.m. – 12:00 p.m.
• Afternoon: 12:00 p.m. – 5:00 p.m.
• Evening: 5:00 p.m. – 12:00 a.m.
• Afternoon: 12:00 p.m. – 7:00 p.m.
• Evening: 7:00 p.m. – 12:00 a.m.

For medico-administrative functions:

• Afternoon: 12:00 p.m. – 7:00 p.m.
• Evening: 7:00 p.m. – 12:00 a.m.

6. Elements of context

Elements of context (éléments de contexte) clarify the conditions under which services were performed.

They can:

• Modify billing rates
• Adjust limitations
• Clarify specific circumstances

Physicians may select one or more elements of context for each billed service.

7. Dispensing site

The dispensing site (lieu de dispensation) identifies where a service is provided.

It may differ from the physical location depending on the service arrangement.

Two types exist:

• Coded sites (physical): Facilities recognized by RAMQ, including hospitals, CLSCs, rehabilitation centres, and FMGs.
• Uncoded sites (geographical): Locations not recognized by RAMQ, which require a postal or location code and status (office, home visit, or other).

Also see: How to choose a RAMQ billing solution

8. Reference site

The reference site (lieu en référence) differs from the dispensing site. It designates where responsibility for the patient or communication originates.

Examples include:

• The facility overseeing patient care during multi-facility on-call duty
• The source of a consultation request or phone call
• The university linked to supervision activities

9. Medico-administrative hourly rate and teaching activities

These are paid at an hourly rate, rather than per act, as they do not involve direct patient care. Physicians receive this type of remuneration for participation in:

• Departmental or administrative meetings
• Academic activities, such as reading clubs or resident instruction

10. Remuneration by act

Under remuneration by act (rémunération à l’acte), physicians bill directly for the services they provide. Compensation is based on the acts submitted for each patient encounter. 

11. Professional reference

A professional reference identifies the healthcare professional who refers a patient for specialized care, diagnostic confirmation, or ongoing treatment. 

Simplify your medical billing in Quebec

Beyond terminology, medical billing can be cumbersome, and leads to wasted time and energy that’s better spent with patients.

Fortunately, Xacte is here to make your billing easier.

Xacte provides real-time recommendations on a wide range of possible errors and provides personalized support from live agents. You’ll access:

• Expert advisors in RAMQ billing.
• A proven web and mobile solution platform to simplify claims.
• Personalized support to help you focus on what matters most: patient care and on-call availability.

Now, go forward and use these medical billing terms with confidence. You’re ready for smarter billing.