RAMQ billing has its unique lexicon. Not surprising that many physicians, especially new ones, get lost. In order to simplify your medical billing, we have listed 11 medical billing terms every doctor should know.
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. Remuneration by Act
With remuneration tied to an act (rémunération à l’acte), a physician bills for the medical services they provide. Physicians are mainly or solely compensated according to the acts that they bill for their patients.
3. Mixed Remuneration
With mixed remuneration (rémunération mixte), a physician is compensated by a combination of the rate of their acts to patients (at a reduced rate) and a fixed rate per half-day. In other words, the mixed remuneration consists of an additional fee that corresponds to a percentage of the rate of the identified services, and a per diem rate.
This type of remuneration is not an individual choice, but instead a service or departmental choice. It is only available in eligible practice sectors and designated institutions. Every professional must obtain an authorization and this authorization request must be submitted by the institution.
It is important to note that this mode of remuneration is only applicable between 7 a.m. and 5 p.m. on weekdays, except on public holidays.
4. Medico-Administrative Hourly Rate and Teaching Activities
This type of remuneration is granted to physicians when they participate in medico-administrative meetings or teaching activities. This could be, for example, a departmental meeting, a reading club, or a course offered to residents.
Participating in such organizational and administrative activities (i.e. that are not directly related to treating patients) is remunerated according to an hourly rate.
List of Activity Codes (pages 22-25) (French only)
5. RAMQ Time Slots
The RAMQ divides the day into four different time slots. A physician has to state the time slot or slots during which s/he has worked in order to procure compensation. The time slots are as follows:
- Night: from 00:00 a.m. to 7:00 a.m.
- Morning: from 7:00 a.m. to 12:00 p.m.
- Afternoon: from 12:00 p.m. to 5:00 p.m.
- Evening: from 5:00 p.m. to 00:00 a.m.
It is important to note that the time slots are different for the hourly rate attached to medico-administrative functions.
- Afternoon: from 12:00 p.m. to 7:00 p.m.
- Evening: from 7:00 p.m. to 00:00 a.m.
6. Premium for Remote Locations
This premium (majoration) is offered to physicians who provide services in territories that have an insufficient supply of healthcare professionals, according to the RAMQ, i.e. in one of these locations (French only). We also call this premium “different remuneration”. Depending on the location where the services are provided and the status of the professional, different compensation rates apply.
To qualify for this premium, a physician must predominantly practice in a remote location, meaning more that 50% of their practice, and they must fill out the Statement of Primary Territorial Practice – Diversified Compensation (French only) annually. A physician who travels to a remote territory to substitute or to offer support still has the right to a minimum bonus.
Table of the Increased Compensation (French only)
7. Elements of Context
Elements of context (éléments de contexte), which we called modifiers (modificateurs) before April 2016, are used to clarify circumstances in which the services were performed. They can influence rates or change certain limitations. To elucidate a situation, a physician can select one or several elements of context for each service provided.
List of Possible Elements of Context (French only)
8. On-Call Availability
We say a physician provides on-call availability (garde en disponibilité) when s/he is available to work and respond to requests, even though they don’t formally have to be physically at the workplace.
There are three types of on-call availability in Quebec:
1. Local On-Call Availability
Local on-call availability (garde locale) refers to the availability of a specialized physician in a healthcare facility.
2. Support On-Call Availability
Support on-call availability (garde en support) refers to the availability of a second specialized physician (in the same discipline or sector of activity) who is available to assist a primary specialized physician in a designated healthcare facility.
3. Multi-Facility On-Call Availability
Multi-facility on-call availability (garde multi-établissements) refers to the availability of a specialized physician who is assigned on-call in one facility, but who is also covering one or more other facilities.
9. Dispensing Site
Usually, a dispensing site (lieu de dispensation) is the place where the service is dispensed (the number of the facility). However, following the negotiations between the FMSQ, the MSSS and the associations, the physician might have to indicate a location different from where s/he rendered the service in certain specific situations.
There are two types of dispensing sites:
Coded Sites (physical)
Coded sites include the healthcare facilities within the province of Quebec, as well as those outside of Quebec, the FMG/U-FMG-U/FMU, CLSC, detention centres, university hospital centres and institutes, rehabilitation centres, etc.
List of Coded Sites (French only)
Uncoded Sites (geographical)
Uncoded sites don’t have a code recognized by the RAMQ. The physician will need to provide a location code or a postal code. The status of the site must also be stated:
- home of the insured person;
List of Locations (French only)
10. Reference Site
A reference site (lieu en référence) is different from a dispensing site. Depending on the service provided, this site must be stated when billing, for example, the number of the facility that takes charge of the patient during a multi-facility on-call availability, the place where the phone call comes from, or the university linked to a supervision.
Like dispensing sites, reference sites can be coded (physical) or not coded (geographical).
11. Professional Reference
This is the healthcare professional that has referred a patient for an opinion regarding a diagnosis or the treatment of a pathology when a patient’s condition seems severe or complex, or to transfer a patient’s care.
Billing Experts Ready to Help You
As you can see, the vocabulary related to medical billing can be complex. But our team is here to help. By choosing Xacte, you get access to the advice of our experts in medical billing and our proven technologic solution.
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