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Balance Billing: Balance billing occurs when a healthcare provider bills he insured for an amount that exceeds what the insurance company is willing to cover. In essence, it is the difference between the amount paid by insurance and the total amount of the bill. Balance billing may or may not be allowable depending on the healthcare provider, the insurance company, or the insurance plan. For example, Medicare risk plan members may not be charged balance billing by contracted healthcare providers.
Balanced Budget Act of 1997: This act represents a federal law that was enacted to reduce the deficit and modify managed care programs like Medicare and Medicaid. It also established a program for increasing state and federal funding for children's healthcare coverage.
Base Capitation: Base capitation refers to a stipulated dollar amount that will cover the cost associated with predefined care per insured person.
Behavioral Healthcare: Refers to the evaluation and treatment (both psychotherapy and pharmaceutical treatments) of mental and substance abuse / addiction disorders.
Beneficiary: The person designated by the insurance organization or supplier to receive insurance benefits.
Benefit Level: Benefit level refers to the degree of service the insured is entitled to based on their health insurance plan. It also refers to the percentage of costs the insurance plan will cover.
Benefit Package: Refers to coverage and reimbursement for healthcare services provided by an insurance company, government agency, or a contractual group health insurance plan.
Benefit Period: The benefit period with the benefits that are payable under an insurance plan or contract.
Benefit Plan: See Health Plan
Bill Review: Refers to a review of excessive medical bills by a third party. Many states require workers' compensation billed charges to be examined.
Billed Claims: Billed claims refer to billed costs for healthcare services that have been extended to an insured party and then submitted to the healthcare provider. Billed claims are sometimes referred to as billed charges.
Biological Equivalents: Sometimes referred to as bio-therapeutic or therapeutic equivalent, biological equivalents refer to the chemical equivalents that provide the same biological or physiological availability, as measured by blood and urine levels, when administered in the same exact amounts.
Board Certified: A board-certified physician is one who has completed their approved residency, passed a medical specialty board examination, and has been certified / licensed as a specialist that their given medical field.
Board Eligible: Refers to a physician who has obtained eligibility to take the specialty board exam. A physician becomes board eligible upon graduation from a certified medical school, has completed specific training regimens, and has practiced for a prescribed period of time.
Brand-Brand Interchange: Scroll to Chemical Equivalents
Bundling: Refers to the packaging of services or costs that could, otherwise, be billed for on a separate basis. For matters of claims processing, bundling includes provider billing for combined healthcare services in accordance with common coding practices. In terms of Medicare, bundling of special benefits offerings is commonplace.