{"id":1617,"date":"2026-05-14T20:06:02","date_gmt":"2026-05-14T20:06:02","guid":{"rendered":"https:\/\/www.petal-health.com\/?p=1617"},"modified":"2026-05-14T20:06:12","modified_gmt":"2026-05-14T20:06:12","slug":"shadow-billing-explained","status":"publish","type":"post","link":"https:\/\/www.petal-health.com\/fr\/blog\/physicians\/shadow-billing-explained\/","title":{"rendered":"Shadow billing explained: What\u00a0it is, how it works, and why it matters"},"content":{"rendered":"\t\t
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Key takeaways<\/h2>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t
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  1. Shadow billing is about tracking activity:\u00a0<\/span><\/b>Physicians\u00a0submit\u00a0claims to capture clinical activity even when they\u00a0aren\u2019t\u00a0paid per service.<\/span><\/li>\n
  2. Accurate shadow billing supports fair compensation:\u00a0<\/span><\/b>Complete data helps\u00a0validate\u00a0workload and strengthen contract negotiations.<\/span><\/li>\n
  3. Shadow billing informs system-level decisions:<\/span><\/b>\u00a0Governments and healthcare organizations rely on this data to\u00a0allocate\u00a0funding and resources, as well as to measure demand.<\/span><\/li>\n<\/ol>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t
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    Shadow billing is the process of\u00a0submitting\u00a0billing claims for medical services that\u00a0aren\u2019t\u00a0paid on a fee-for-service\u00a0(FFS)\u00a0basis. Instead, this information is\u00a0used to track physician activity, workload, and care delivery.<\/span><\/p>\n

    Although it doesn\u2019t directly generate payment per claim, it remains critical to how physicians are compensated, how healthcare systems allocate funding, and how care delivery is measured.<\/span><\/p>\n

    As more Canadian physicians moved into alternative payment models (APMs),\u00a0such as salaries, contracts, or blended funding, shadow billing became essential.\u00a0This is because data collected from shadow billing has a direct impact on individual\u00a0physicians and the healthcare system at large.<\/span><\/p>\n

    FFS\u00a0has declined in recent years\u00a0(to about ~70% of billings) in Canada\u00a0but persists. As\u00a0<\/span>Canada talks\u00a0value but still pays for volume<\/span><\/a>, understanding\u00a0shadow billing is critical if physicians are expected to bill less using FFS.\u00a0This matters:\u00a0<\/span>Evidence consistently shows<\/span><\/a>\u00a0higher patient satisfaction and slower spending growth in team-based, value-oriented models.<\/span><\/p>\n

    Read on to learn what shadow billing is, how it works in practice, and why it matters for physicians across Canada.<\/span><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t

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    What\u2019s shadow billing?<\/span><\/span><\/h2>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t
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    Shadow billing is the submission of standard medical billing codes for services provided without receiving direct fee-for-service payment for each claim.<\/span><\/p>\n

    In Canada, shadow billing is most used in alternative payment models.\u00a0These are commonly found in\u00a0hospital-based roles, academic settings, and group funding arrangements. Instead of being paid per visit or procedure, physicians may receive a salary, sessional payments, or blended compensation.\u00a0<\/span>They\u2019re\u00a0still\u00a0required to\u00a0submit\u00a0claims as if they were billing fee-for-service<\/span><\/b>.<\/p>\n

    The key difference between shadow billing and fee-for-service is intent. In a fee-for-service model, each claim results in payment. In shadow billing, the claim is recorded for\u00a0accountability\u00a0and system-level insights.<\/span><\/p>\n