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Balance Billing - The practice of billing a patient for the fee quantity remaining after insurer payment and co-payment have been prepared. Under Medicare, the excess amount cannot be more than 15 percent above the accepted charge.

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Base Capitation - Specified amount for a person per month to cover healthcare cost, usually not including pharmacy and administrative costs as well as optional coverages such as mental health or substance abuse services.

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Base Year Costs - In Medicare, the amount a hospital actually exhausted to render care in a previous time period. Depending on the hospital's Medicare cost treatment period, the base year was the fiscal year ending on or after September 30, 1982 and before September 30, 1983 for hospitals in process at that time. Recent legislation has complete dramatic changes in cost reporting opportunities for healthcare providers, limiting these reimbursements.

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Bed Days - Number of inpatient in hospital days per 1,000 health plan members for a particular period, usually annual.

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Behavioral Health, Behavioral Healthcare - An umbrella term that includes mental health, psychiatric, marriage and family counseling, addictions treatment and material abuse. Services are provided by a myriad of providers, including social workers, counselors, psychiatrist, psychologists, neurologists and even relations practice physicians. Many states have "parity" laws that effort to require that behavioral health insurance coverage be provided "on par" to physical health coverage.

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Behavioral Offset - This is the alteration in the number and type of services that is probable to occur in response to a change in fees. A 50 percent behavioral offset suggest that 50 percent of the savings from fee reductions will be equalizing by increased volume and strength of services.

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Benchmark - It is a rule that to be attained goal. These goals are chosen by comparisons with other providers, by consulting statistical information available or are drawn from the best practices within the business or industry. Benchmarks are used in quality improvement programs to encourage development of care, efficiencies or services. Benchmarks are also used for extent of stay comparisons, costs, utilization review, risk management and financial analysis. The benchmarking process identifies the best performance in the industry for a particular procedure or outcome, determines how that performance is achieved, and applies the lessons educated to improve performance.

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Beneficiary - Individual who is also using or eligible to use insurance benefits, including health insurance benefits, under an insurance contract. A person who is eligible for a subscriber or a dependent for a managed care service in agreement with a contract. An individual who receives benefits from or is enclosed by an insurance policy or other health care financing program.

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Beneficiary Liability - The amount beneficiary must pay providers for Medicare-covered services. Liabilities comprise co-payments, deductibles, and balance billing amounts. CMS has very severe rules about health providers billing patients for their liabilities. Cost based facilities are not allowable to charge non-payment by beneficiaries to bad balance unless a clear history of collection movement is recorded.

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Benefit Limitations - Any condition, other than an elimination, which restricts coverage in the Evidence of Coverage, regardless of medical necessity. Limitations are often uttered in terms of dollar amounts, length of stay, diagnosis or treatment descriptions.

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Benefit Package - Combined services specifically defined by an insurance policy or HMO that can be providing to patients. The services a payer offer to a group or individual. The package will specify comprise cost, limitation on the amounts of services, and annual or lifetime spending limits.

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Benefit Payment Schedule - List of amounts an insurance plan will recompense for covered health care services.

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Benefits - Benefits are specific areas of Plan coverage's like outpatient visits, hospitalization and so forth, that makes up the range of medical services that a payer markets to its subscribers. Also, a contractual accord, specified in an Evidence of Coverage, determining enclosed services provided by insurers to members.

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Billed Claims - The Fees submitted by a health care provider for services rendered to a covered person. Fees billed and fees paid are rarely identical.

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Biometric Identifier - Identifying information based on a physical characteristic such as fingerprint. Confidentiality laws and HIPAA privacy policy refer to biometric identifiers.

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Bioterrorism or Biological Warfare - The illegal use, wartime use, or threatened use, of microorganisms or toxins to produce death or disease in humans. Often viewed as the favored choice of warfare of less powerful groups of people in effort to wage war or protect themselves from more potent groups or nations. However, biological agent could be used by individuals or by powerful nations as well.

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Block Grant - Federal funds complete to a state for the delivery of a specific group of connected services, such as drug abuse related services.

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Board Certified - Describes a physician who has accepted a written and oral examination given by a medical specialty board and who has been qualified as a specialist in that area.

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Board Eligible - Describes a physician who is suitable to take the specialty board examination by virtue of being graduated from an permitted medical school, completing a definite type and length of training, and practicing for a particular amount of time. Some HMOs and other health services accept board eligibility as correspondent to board certification, significant in that many managed care companies control referrals to physicians without certification.

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Bonus Payment - An extra amount paid by Medicare for services provided by physicians in Health Professional Shortage Areas. Presently, the bonus payment is 10 percent of Medicare's share of allowed charges. This is not to be confused with other payments to hospitals, such as the unbalanced share payment or the settlement made to facilities at the end of a cost report year.

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Brand Name Drug - Prescription drug which is marketed with a specific brand name by the company that manufactures it. May cost insured individuals higher co-pay than generic drugs on some health plans.

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Bundled Payment - A single wide-ranging payment for a collection of associated services. Bundled payments have turn into the norm in recent years and CMS and other payers investigate unbundled services closely. Unbundling service charge has been a common form of fraud as defined by CMS.

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Business Associate - Under HIPAA rules, this term refers to an outside person or entity that performs a service on behalf of the health care provider or the health care institution during which independently identifiable health information is created, used, or disclosed. For example, web hosting or data storage companies will be business associates if they obtain protected health information. In addition, third parties that hold billing for a research study, or recruitment and screening will also be business associates.

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Broker - The person who represents an insured in solicitation, negotiation, or procurement of contracts of insurance, and who may provide services secondary to those functions. By law, the broker may also be a mediator of the insurer for certain purposes such as delivery of the policy or compilation of the premium.

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