10 Common Quebec medical resident questions answered

Key takeaways

1. Early RAMQ registration pays off: Completing your CMQ and RAMQ setup before starting independent practice limits payment delays to support a smoother transition from residency.
2. Understanding billing codes protects your revenue: Knowing eligible services and code combinations reduces missed payment opportunities.
3. Remuneration models determine how you're compensated: Fee-for-service, hourly, and mixed arrangements involve different payment calculations and admin requirements.

Starting independent practice in Quebec requires completing key steps. Among them, physicians need to register with the Régie de l'assurance maladie du Québec (RAMQ), understand their remuneration model, and establish a reliable medical billing process.

For graduating residents, learning the ins and outs of billing is critical to starting strong post-residency.

From selecting billing codes to submitting claims and reviewing payments, billing knowledge is essential to receiving accurate compensation for delivered care.

But medical billing isn't always covered in detail during residency.

Through recent webinars and conversations with Quebec medical residents, our billing experts have heard plenty of questions about getting paid and navigating RAMQ requirements.

We've answered 10 common questions to prepare you for the financial and administrative responsibilities of medical practice in Quebec.

1. What do I need to set up before I can start billing with RAMQ?
2. How does RAMQ billing work, from seeing a patient to getting paid?
3. How do I know which RAMQ billing codes to use?
4. Can I bill multiple services for the same patient on the same day?
5. What's the difference between fee-for-service, hourly, and mixed remuneration in Quebec?
6. Can I earn more for working evenings, weekends, or in remote regions?
7. How long do I have to submit or correct RAMQ billing claims?
8. What happens if RAMQ refuses my claim or reviews my billing?
9. Can I get a head start on RAMQ billing through moonlighting before residency ends?
10. Should I manage my RAMQ billing myself or use a billing solution?

1. What do I need to set up before I can start billing with RAMQ? 

Before submitting your first RAMQ claim, you'll need authorization to practice independently, completed RAMQ registration, and any additional practice authorizations that may be required.

Here's where to start:

1. Obtain your practice permit through the Collège des médecins du Québec (CMQ).
2. Secure your practice position where applicable:
   • Family physicians: Confirm an approved position under the PTEM (Plan territorial des effectifs médicaux), formerly PREM.
   • Specialists: Confirm an appointment that complies with the PEM (Plan d'effectifs médicaux) requirements applicable to your specialty and healthcare establishment.
3. Register with RAMQ to obtain your professional number and reference number.
4. Activate your RAMQ online account through the secure portal.
5. Confirm your banking details and billing arrangements for direct deposit and remittance processing.
6. Ensure your professional liability insurance is updated from resident status to independent practice.

Tip: Start your PTEM/PEM confirmation and RAMQ registration well ahead of your first day.

2. How does RAMQ billing work, from seeing a patient to getting paid?

RAMQ billing follows a predictable process, from the moment you provide care until payment reaches your account.

For physicians billing fee-for-service, the basic steps are:

1. Provide care: Confirm the patient's eligibility and document the encounter.
2. Select codes: Identify the appropriate billing codes and contextual elements.
3. Submit claims: Send your billing information electronically to RAMQ.
4. Review your account statement: Check which claims were paid, adjusted, or refused.
5. Receive payment: Confirm that your compensation matches the services you've billed.

RAMQ generally operates on a biweekly payment cycle, publishing an état de compte (account statement) with payment and processing details.

Remember: Your billing responsibilities continue after submission. Make sure you review account statements to identify missed payments.

3.  How do I know which RAMQ billing codes to use?  

The correct RAMQ billing code depends on the service provided and your medical specialty, as well as the applicable remuneration agreement.

Quebec physicians follow different billing frameworks depending on their field:

• Family physicians: Consult the RAMQ manuals and agreements applicable to general practitioners.
• Medical specialists: Consult the billing rules established under the specialist agreement.

For example, a family physician conducting a routine consultation, and a specialist performing a procedure, may face different eligibility requirements.

Tip: Understand your most common codes first, then gradually build your knowledge of premiums and special situations.

Also see: 11 Medical billing terms Quebec physicians should know

4. Can I bill multiple services for the same patient on the same day? 

Yes, certain RAMQ services can be billed together, provided that each meets applicable requirements.

For example, a physician may perform a consultation and a separate procedure during the same encounter. Whether both qualify for payment depends on the relevant agreement and any restrictions on combining codes.

Before submitting multiple claims, confirm that:

• Each service is separately eligible for payment.
• The billing codes are compatible.
• Your clinical documentation supports services provided.

These rules differ between family medicine and medical specialties, so consult your relevant RAMQ billing manual.

In practice: Two valid codes don't necessarily qualify for payment when submitted together.

5. What's the difference between fee-for-service, hourly, and mixed remuneration in Quebec?

Quebec physicians may receive compensation through different remuneration models, depending on their specialty, workplace, and negotiated agreements.

Three important models to understand are:

• Fee-for-service: You receive compensation for individual, eligible services billed to RAMQ.
• Hourly remuneration: Your payment is based on eligible hours worked in designated practice settings, subject to your applicable agreement.
• Mixed remuneration: Compensation combines an hourly component with supplementary payments tied to services.

In practice, a family physician working in certain public establishments may qualify for hourly or mixed remuneration. Specialists have their own agreements, including specialty-specific payment arrangements.

Key action: Confirm your remuneration model and its billing requirements before beginning a new position.

6. Can I earn more for working evenings, weekends, or in remote regions? 

Yes. Certain physicians in Quebec qualify for additional remuneration based on when and where they practice.

Depending on your specialty and agreement, eligible compensation may include:

• After-hours premiums: Additional payments for certain services performed during evenings, nights, weekends, or statutory holidays.
• Regional premiums: Increased remuneration for eligible physicians practicing in designated remote or peripheral regions.
• Other supplements: Payments tied to specific clinical responsibilities or practice conditions.

For example, a physician working in a designated remote region may qualify for regional remuneration adjustments.

Tip: Always record accurate service times and locations.

7.  How long do I have to submit or correct RAMQ billing claims? 

Quebec physicians generally have 90 days from the date of service to submit an initial RAMQ claim.

Separate deadlines apply when modifying or requesting a review of previously processed claims.

For example, physicians billing fee-for-service generally have 90 days from the date of the relevant account statement to modify a claim.

Although these deadlines provide some flexibility, it's best to establish a consistent billing routine:

• Daily: Record completed encounters.
• Weekly: Submit outstanding claims.
• Every payment cycle: Review account statements and investigate refusals.

Key action: Confirm which correction or review procedure applies to your remuneration model before resubmitting a claim.

8. What happens if RAMQ refuses my claim or reviews my billing?

RAMQ may refuse, adjust, or return claims when billing information doesn't meet requirements.

Common issues include incorrect codes, missing contextual information, incompatible services, and incomplete documentation.

If your claim is refused:

1. Review the explanatory code on your RAMQ account statement.
2. Identify what information needs correcting.
3. Submit the appropriate correction or review request within the required deadline.

RAMQ can also review claims after payment to verify that the services were provided and properly documented.

Remember: A paid claim isn't necessarily exempt from future verification.

9.  Can I get a head start on RAMQ billing through moonlighting before residency ends?

Yes. Eligible Quebec medical residents can earn additional income through authorized clinical work, commonly called moonlighting.

However, eligibility varies. It depends on your training status, medical licence, insurance coverage, specialty, and practice location.

Certain specialty residents who have completed an initial certification may qualify to perform additional clinical work. Family medicine residents pursuing additional training may also qualify for specific practice arrangements.

Before accepting additional shifts, confirm:

• Your eligibility to practice independently
• Required institutional or regional authorizations
• Your remuneration and RAMQ obligations

Remember: Additional work must comply with the conditions attached to your authorization.

10.  Should I manage my RAMQ billing myself or use a billing solution?

The right RAMQ billing approach depends on your specialty, workload, budget, and preferred level of administrative involvement.

Quebec physicians generally have four options:

1. Self-managed software: Enter and manage claims independently.
2. Clinic administrative support: Rely on staff to prepare and submit billing.
3. Billing agency: Outsource claim processing and follow-up.
4. Hybrid solution: Combine billing software with expert review and support.

As a new physician, consider whether your chosen approach provides training, current billing rules, error validation, and payment monitoring.

Remember: You're ultimately responsible for the accuracy of your claims, even when someone else manages submissions.

Start your RAMQ billing career with confidence 

Establishing strong billing habits will show up in your short- and long-term revenue.

At Xacte by Petal, we support 11,500+ Quebec physicians through the complexities of RAMQ billing.

Our solution combines intelligent billing technology with local expertise to simplify the administrative side of medical practice.

You'll benefit from:

• Real-time claim validation to identify potential errors before submission
• Personalized training adapted to your specialty and practice
• Mobile and web access to manage billing wherever you work
• Access to Quebec-based medical billing experts when questions arise

Make your first billing step a stable one. Trust your knowledge and expert guidance to launch right!

FAQs: RAMQ billing for Quebec medical residents

When should medical residents register with RAMQ?

Ideally, begin preparing your registration before your first day of independent practice. You'll need the appropriate CMQ authorization and professional information before completing your RAMQ billing setup. Starting early reduces the risk of payment delays.

Do family physicians and specialists follow the same RAMQ billing rules?

No. Family physicians and medical specialists operate under different negotiated agreements, with distinct billing codes, eligible services, premiums, and remuneration provisions. Always consult the RAMQ documentation applicable to your specialty.

Can I change RAMQ billing providers after starting practice?

Yes. You can generally change billing providers as your practice evolves. Before switching, confirm how outstanding claims, billing records, account authorizations, and payment follow-up will be managed during the transition.

Do I need to incorporate when I finish residency in Quebec?

No. Incorporation isn't automatically required when entering independent practice. Your decision should reflect your compensation arrangements, financial circumstances, and long-term goals. Consult an accountant experienced in Quebec medical practice before choosing a business structure.

Can Quebec physicians bill for patients from other provinces?

In certain circumstances, yes. However, interprovincial billing arrangements differ depending on the patient's province, the services provided, and the applicable reimbursement rules. Verify the appropriate payment process before submitting claims or charging patients directly.

How can I tell whether I'm underbilling with RAMQ?

Compare your documented services against eligible billing codes, premiums, and contextual elements under your agreement. Review account statements for reduced payments or recurring discrepancies. A qualified RAMQ billing professional can also identify patterns that may indicate missed compensation.