Term Definition
BABY BOOM

The period from the end of World War II through the mid-1960s marked by unusually high birth rates.

BALANCE BILLING

A situation in which Private Fee-for-Service Plan providers (doctors or hospitals) can charge and bill you 15% more than the plan's payment amount for services.

BASE ESTIMATE

The updated estimate of the most recent historical year.

BASIC BENEFITS

Basic Benefits includes both Medicare-covered benefits (except hospice services) and additional benefits.

BASIC BENEFITS (MEDIGAP POLICY)

Benefits provided in Medigap Plan A. They are also included in all other standardized Medigap policies. (See Medigap Policy.)

BENCHMARK

A benchmark is sustained superior performance by a medical care provider, which can be used as a reference to raise the mainstream of care for Medicare beneficiaries. The relative definition of superior will vary form situation to situation. In many instances an appropriate benchmark would be a provider that appears in the top 10% of all providers for more than a year.

BENEFICIARY

The name for a person who has health care insurance through the Medicare or Medicaid program.

BENEFICIARY ENCRYPTED FILE

A restricted public use file. An Agreement for Release of the Centers for Medicare & Medicaid (CMS) Beneficiary Encrypted Files (PDF, 13KB) data
use agreement is required.

BENEFICIARY NOTIFICATION LETTER

A letter that is required with CMS Administrator's signature when Medicare
beneficiaries will be contacted to participate in a research project.

BENEFIT PAYMENTS

The amounts disbursed for covered services to beneficiaries after the deductible and coinsurance amounts have been deducted.

BENEFIT PERIOD

The way that Medicare measures your use of hospital and skilled nursing facility (SNF) services. A benefit period begins the day you go to a hospital or skilled nursing facility. The benefit period ends when you haven't received any hospital care (or skilled care in a SNF) for 60 days in a row. If you go into the hospital or a skilled nursing facility after one benefit period has ended, a new benefit period begins if you are in the Original Medicare Plan. You must pay the inpatient hospital deductible for each benefit period. There is no limit to the number of benefit periods you can have.

BENEFITS

The money or services provided by an insurance policy. In a health plan, benefits are the health care you get.

BENEFITS DESCRIPTION (PLAN)

The scope, terms and/or condition(s) of coverage including any limitation(s) associated with the plan provision of the service.

BIOLOGICALS

Usually a drug or vaccine made from a live product and used medically to diagnose, prevent, or treat a medical condition. For example, a flu or pneumonia shot.

BIOMETRIC IDENTIFIER

An identifier based on some physical characteristic, such as a fingerprint.

BIRTHING CENTER

A facility, other than a hospital's maternity facilities or a physician's office, which provides a setting for labor, delivery, and immediate post-partum care as well as immediate care of new born infants.

BLOOD UREA NITROGEN

The term BUN refers to the substance urea, which is the major breakdown product of protein metabolism, and is ordinarily removed by the kidneys. During kidney failure, ure accumulates in proportion to the degree of kidney failure and to the amount of protein breakdown. The symptoms of uremia correspond roughly to the amount of urea in the blood stream.

BLUE CROSS AND BLUE SHIELD ASSOCIATION

An association that represents the common interests of Blue Cross and Blue Shield health plans. The BCBSA serves as the administrator for the Health Care Code Maintenance Committee and also helps maintain the HCPCS Level II codes.

BOARD AND CARE HOME

A type of group living arrangement designed to meet the needs of people who cannot live on their own. These homes offer help with some personal care services.

BOARD HEARING

That hearing provided for in section 1878(a) of the Act (42 U.S.C. 139500(a)) and 42 CFR ยง405.1835.

BOARD OF TRUSTEES

A Board established by the Social Security Act to oversee the financial operations of the Federal Supplementary Medical Insurance Trust Fund. The Board is composed of six members, four of whom serve automatically by virtue of their positions in the federal government: the Secretary of the Treasury, who is the Managing Trustee; the Secretary of Labor; the Secretary of Health and Human Services; and the Commissioner of Social Security. The other two members are appointed by the President and confirmed by the Senate to serve as public representatives. John L. Palmer and Thomas R. Saving began serving their 4-year terms on October 28, 2000. The Administrator of CMS serves as Secretary of the Board of Trustees.

BOARD-CERTIFIED

This means a doctor has special training in a certain area of medicine and has passed an advanced exam in that area of medicine. Both primary care doctors and specialists may be board-certified.

BODY RECORD

The body or data record contains information on a single OASIS-B1 patient assessment.

BOND

A certificate of ownership of a specified portion of a debt due by the federal government to holders, bearing a fixed rate of interest.

BONUS

Means a payment a physician or entity receives beyond any salary, fee-for-service payments, capitation or returned withhold. Bonuses and other compensation that are not based on referral or utilization levels (such as bonuses based solely on quality of care, patient satisfaction or physician participation on a committee) are not considered in the calculation of substantial financial risk.

BUSINESS ASSOCIATE

A person or organization that performs a function or activity on behalf of a covered entity, but is not part of the covered entity's workforce. A business associate can also be a covered entity in its own right. Also see Part II, 45 CFR 160.103.

BUSINESS MODEL

A model of a business organization or process.

BUSINESS PARTNER

See Business Associate.

BUSINESS RELATIONSHIPS

The term agent is often used to describe a person or organization that assumes some of the responsibilities of another one. This term has been avoided in the final rules so that a more HIPAA-specific meaning could be used for business associate.


*NOTE: An asterisk (*) after a term means that this definition, in whole or in part, is used with permission from Walter Feldesman, ESQ., Dictionary of Eldercare Terminology, Copyright 2000.