Key takeaways
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.
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:
Tip: Start your PTEM/PEM confirmation and RAMQ registration well ahead of your first day.
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:
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.
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:
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
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:
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.
Quebec physicians may receive compensation through different remuneration models, depending on their specialty, workplace, and negotiated agreements.
Three important models to understand are:
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.
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:
For example, a physician working in a designated remote region may qualify for regional remuneration adjustments.
Tip: Always record accurate service times and locations.
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Starting to bill as a Quebec physician? Get what you’ve earned. |
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:
Key action: Confirm which correction or review procedure applies to your remuneration model before resubmitting a claim.
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:
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.
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:
Remember: Additional work must comply with the conditions attached to your authorization.
The right RAMQ billing approach depends on your specialty, workload, budget, and preferred level of administrative involvement.
Quebec physicians generally have four options:
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.
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:
Make your first billing step a stable one. Trust your knowledge and expert guidance to launch right!
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Earn what you deserve from day one: |
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.