A B C D E F G H I J L M N O P Q R S T U V W Y

balance billing

A provider’s bill to a covered person for charges above the amount paid by the health plan or insurer. In some cases this is because a provider is not part of the insurer’s network.

basic health program (BHP)

Beginning in 2015 under the Affordable Care Act (ACA), states have the option to create a basic health program to provide coverage to individuals with incomes between 133 and 200 percent of the federal poverty level, in lieu of having these individuals get coverage and premium subsidies through the state’s health insurance exchange. The plan would exist outside of the health insurance exchange and would include the essential health benefits as defined under the ACA. Cost-sharing under this plan would also be limited. If states choose to offer this plan, the federal government will provide states 95 percent of what it would have paid to subsidize these enrollees in the health insurance exchange. So far, only Minnesota and New York have chosen to implement a basic health program.

benchmarks

Goals set as a way for hospitals and doctors to analyze quality data, both internally, and against data from other hospitals and doctors to identify best practices of care and improve quality.

best practices

The most up-to-date patient care methods, which result in the best patient outcomes and minimize patient risk of death or complications.

biologic

A medicine derived from living cells cultured in a laboratory.

Biologics Price Competition and Innovation Act (BPCIA)

The Affordable Care Act amends the Public Health Service Act to create an abbreviated licensure pathway for biological products that are demonstrated to be “biosimilar” to or “interchangeable” with an FDA-licensed biological product. This pathway is provided in the part of the law known as the Biologics Price Competition and Innovation Act (BPCIA). Under the BPCIA, a biological product may be demonstrated to be “biosimilar” if data show that, among other things, the product is “highly similar” to an already-approved biological product.

biosimilar

A drug with a similar composition to its biologic “reference” drug that has no differences in safety, potency, or purity.

biosurveillance

Automated monitoring of health data sources to identify trends that may indicate an emerging epidemic, whether naturally occurring or as a result of bioterrorism.

block grant

A lump sum of money that the federal government gives to a state or local government to spend for certain purposes. Normally, it is based on a formula, the objectives are broadly defined, and the grant’s source places relatively few limits on the money’s use.

bundled payments

A form of provider payment in which providers or hospitals receive a single payment for all of the care provided for an episode of illness, rather than per service rendered. Total care provided for an episode of illness may include both acute and post-acute care. The Affordable Care Act (ACA) established pilot programs in Medicare and Medicaid to pay a bundled payment for episodes of care involving hospitalizations.