Operation Ignite: Understanding Benefit Structures and Coverage Foundations
Before diving into the core session, this focused discussion will clarify the critical distinctions between claim denials and rejections—two terms often used interchangeably but with very different operational and financial implications. Attendees will learn how to identify the root causes of each, understand their impact on reimbursement timelines, and apply best practices for timely and accurate resolution.
- Review the benefits of design and payer coverage structure.
- Learn how to identify key differences between medical and pharmacy benefits.
- Recognize indicators that influence billing pathways.
Operation Elevation: Determining Whether to Bill Under the PBM or the Medical Benefit
Attendees will gain insight into the most common causes of payment delays in home and alternate site infusion operations. The session will explore where breakdowns most often occur—from authorization to claim submission to payer follow-up—and provide practical strategies to minimize these interruptions and improve overall revenue performance.
- Master the decision-making process for determining whether to bill a patient’s therapy under the Pharmacy Benefit Manager (PBM) or the medical benefit.
- Learn how to assess the therapy type, coverage criteria, and supporting documentation to establish the appropriate billing flow.
- Learn how proper benefit determination impacts reimbursement, compliance and overall revenue cycle efficiency.
Operation Ignite: Applying Benefit Decisions to Optimize Billing Outcomes
This follow-up session will demonstrate how to leverage key operational and financial metrics to pinpoint revenue barriers and track performance improvements. Participants will explore how data-driven dashboards and trend analysis can reveal underlying issues in billing flow, payer response, and collections—helping teams transition from reactive troubleshooting to proactive revenue management.
- Learn to apply benefit determination decisions to real-world billing scenarios.
- Learn how to analyze payer responses, identify when reclassification or appeals may be warranted.
- Learn to use process metrics to measure the financial and operational impact of benefit selection.
NHIA General CE Information
Jeanne Lugli
Sr Director RCM
Brightree
Jeanne Lugli has 40+ years’ experience in infusion reimbursement. First at Caremark in a variety of reimbursement roles from intake to a Reimbursement Manager. Next at Home Intensive Care as a Regional Reimbursement Manager for 13 locations until it was acquired. This led to a role at Healthcare Automation which eventually became WellSky. There she initially providing specialty consulting before creating the home infusion RCM services which she managed for the next 25 years. Since 2020, she is a Sr. Director on the Pharmacy RCM team at Brightree. She has been on the NHIA PAR since 2007. Lastly, Jeanne is an NHIA Fellow from the inaugural class.
NHIA Requires planners, faculty, and others who affect the content of this activity to disclose all financial relationships they have with ineligible companies. All relevant financial relationships are thoroughly vetted and mitigated according to policy.
Jeanne Lugli has no relevant financial relationships with ineligible companies to disclose.
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Operation Ignite: Understanding Benefit Structures and Coverage Foundations
Operation Ignite: Understanding Benefit Structures and Coverage Foundations - Live
08/18/2026 at 12:00 PM (EDT) | 15 minutes
08/18/2026 at 12:00 PM (EDT) | 15 minutes
Post Education Survey - (OI1) Live
8 Questions
8 Questions
Operation Ignite: Understanding Benefit Structures and Coverage Foundations
NHIA Live Webinar - 0.25 CE
Required to Claim (OI1) Live CE
Up to 0.25 medical credits available | Certificate available
Up to 0.25 medical credits available | Certificate available
**PHARMACISTS & PHARMACY TECHNICIANS MUST SELECT THE BLUE "CLAIM CREDIT" BUTTON & ENTER YOUR DOB IN ORDER TO RECEIVE CE CREDIT**
________________________________________________________________________________________________________________________________________________________________________
NHIA adheres to the ACCME’s Standards for Integrity and Independence in Accredited Continuing Medical Education. Any individuals in a position to control the content of a CME/CE activity, including faculty, panelists, planners, reviewers, or others are required to disclose all relevant financial relationships with ineligible entities (commercial interests). All relevant conflicts of interest have been mitigated prior to the commencement of the activity.
Please note that the certificates printed from this platform are invalid as proof of continuing education (CE). For official documentation of CE credits, please print a paper statement of credit from your NABP e-profile.
Operations Elevation: Determining Whether to Bill Under the PBM or the Medical Benefit
Operations Elevation: Determining Whether to Bill Under the PBM or the Medical Benefit - Live
08/19/2026 at 12:00 PM (EDT) | 30 minutes
08/19/2026 at 12:00 PM (EDT) | 30 minutes
Post Education Survey - (OE) Live
8 Questions
8 Questions
Operations Elevation: Determining Whether to Bill Under the PBM or the Medical Benefit
NHIA Live Webinar - 1.0 CE
Required to Claim (OE) Live CE
Up to 0.50 medical credits available | Certificate available
Up to 0.50 medical credits available | Certificate available
**PHARMACISTS & PHARMACY TECHNICIANS MUST SELECT THE BLUE "CLAIM CREDIT" BUTTON & ENTER YOUR DOB IN ORDER TO RECEIVE CE CREDIT**
________________________________________________________________________________________________________________________________________________________________________
NHIA adheres to the ACCME’s Standards for Integrity and Independence in Accredited Continuing Medical Education. Any individuals in a position to control the content of a CME/CE activity, including faculty, panelists, planners, reviewers, or others are required to disclose all relevant financial relationships with ineligible entities (commercial interests). All relevant conflicts of interest have been mitigated prior to the commencement of the activity.
Please note that the certificates printed from this platform are invalid as proof of continuing education (CE). For official documentation of CE credits, please print a paper statement of credit from your NABP e-profile.
Operation Ignite: Applying Benefit Decisions to Optimize Billing Outcomes
Operation Ignite: Applying Benefit Decisions to Optimize Billing Outcomes
08/20/2026 at 12:00 PM (EDT) | 15 minutes
08/20/2026 at 12:00 PM (EDT) | 15 minutes
Post Education Survey - (OI2) Live
8 Questions
8 Questions
Operation Ignite: Applying Benefit Decisions to Optimize Billing Outcomes
NHIA Live Webinar - 0.25 CE
Required to Claim (OI2) Live CE
Up to 0.25 medical credits available | Certificate available
Up to 0.25 medical credits available | Certificate available
**PHARMACISTS & PHARMACY TECHNICIANS MUST SELECT THE BLUE "CLAIM CREDIT" BUTTON & ENTER YOUR DOB IN ORDER TO RECEIVE CE CREDIT**
________________________________________________________________________________________________________________________________________________________________________
NHIA adheres to the ACCME’s Standards for Integrity and Independence in Accredited Continuing Medical Education. Any individuals in a position to control the content of a CME/CE activity, including faculty, panelists, planners, reviewers, or others are required to disclose all relevant financial relationships with ineligible entities (commercial interests). All relevant conflicts of interest have been mitigated prior to the commencement of the activity.
Please note that the certificates printed from this platform are invalid as proof of continuing education (CE). For official documentation of CE credits, please print a paper statement of credit from your NABP e-profile.
