Partnering for the People of North Carolina

2018 Alliance sponsor feature article provided courtesy of UnitedHealthcare

From technology and patient needs to payment models and innovative partnerships, trends are converging in a rapid and exciting fashion. We’re all in it together: patients, physicians and care providers, and payers. UnitedHealthcare Community Plan shares your commitment to delivering a superior patient experience and improving health outcomes.

We believe that the best solutions come when we work together with care providers. We share the power to chart a new path, creating a stronger health care system that works better for everyone. And we’re ready to support you with tools and data resources designed to help you serve your patients and allow your practice to thrive.

Our Promise to the people of North Carolina:

Health care is constantly changing in North Carolina and throughout the country, and all stakeholders – individuals, care providers, community partners and federal and state governments – feel the impact. In the face of this changing landscape, the business and social mission of UnitedHealthcare will always remain the same: To help people live healthier lives and to help make the health system work better for everyone.

We have a long history in the great state of North Carolina and are proud of our record improving the health of more than 1.4 million people we are privileged to serve through the delivery of quality, cost-effective health care. We are committed to continuing to serve North Carolinians and working together to move the new Medicaid program forward today and for the future.

UnitedHealthcare has update its After-hours reimbursement policy for commercial plans in North Carolina

Beginning July 1, 2018, UnitedHealthcare will reimburse Primary Providers for CPT Code 99051 “Services provided in the office on evenings, weekends or holidays when Office is normally schedule to be open” when billed with a non-preventative office visit.

  • 99051: Eligible expenses for after-hours health services will be reimbursed at a value determined using the alternate of (‘gap-fill’) Fee Source as CMS does not publish an RVU value for the code.

This policy update will be effective for claims with dates of service July 1, 2018 and after. A national policy update will be implemented later in 2018.

If you have any questions about this policy update please contact Provider Relations at and include your practice name, tax ID number and National Provider Identifier to assist us in identifying your assigned Advocate. The reimbursement rate for CPT code 99051 will be available via the fee schedule lookup tool in Link beginning 07/01/2018.


Greensboro Multi-Payer Provider Expo on August 16th

Greensboro Multi-Payer Provider Expo

August 16, 2018
Sheraton Greensboro Four Seasons
3121 W. Gate City Blvd.
Greensboro, NC 27407

Mark your calendars and make plans to attend the Greensboro Multi-Payer Provider Expo sponsored by Blue Cross Blue Shield of North Carolina, United Healthcare and MedCost.

Schedule of Events

8:00 AM – 1:00 PM — Exhibit Hall Open
9:00 AM – 10:00 AM — Helping Providers Succeed in Value Based Care
10:00 AM – 11:00 AM — Design Thinking and the Millennial Patient


Follow this link for a printable registration form. Please fax completed registration form to (855) 754-3681 by Friday, August 10, 2018.

Catch Up with NCMGMA This Summer

Catch up with the North Carolina Medical Group Management Association (NCMGMA) this summer at the following events:

  • NCHA Summer Meeting: July 18th – 20th in Asheville, NC where NCMGMA will be exhibiting! Click here for more information.
  • United Healthcare Roadshow: August 16, 2018 in Greensboro
  • United Healthcare Roadshow: Sept 13, 2018 in Durham

Also, visit the NCMGMA website calendar of events to find out about local chapter meetings happening in your area.

Marketing Budgets: Is Your Approach Strategic? Or Seat-of-the-Pants?

By Gail Schwartz

2018 Alliance Sponsor feature article provided courtesy of Marketing Works

Medical practices don’t make operational changes based on the “crisis of the day,” nor do they develop clinical protocols without careful consideration and research. So why, when it comes to planning a marketing budget (the one budget line item that can grow your practice), should you take a less than strategic approach?

Without systematic planning, you’re likely to make some of the following mistakes that cost you money without delivering the desired results.

  • Seat-of-the-pants, “make-it-up-as-you-go” budgeting. An ad rep calls and offers a practice administrator a “great deal” on billboards, or on space in a regional lifestyle magazine. The deal sounds too good to turn down, but there is no ongoing, strategy-driven campaign. So, you allow the outdoor company or the magazine to create your message so you don’t miss the opportunity. As a stand-alone tactic without a message that supports practice goals, you’ll end up with a one-legged dog that doesn’t run very fast and a message that tries to tell your entire story. What did this one-shot initiative accomplish? Was this money well spent?
  • Underbudgeting. Guess what the most likely outcome is of a wimpy budget? Wimpy (or no) results. Business researchers have known for more than a century that the key to successful marketing is repetition of on-strategy messages to the right audiences at the right time and in the right place. Current research backs up this foundational marketing principle (Schmidt & Eisend, 2015). That means that running a single online campaign after finding out that one of your physicians has a cousin who “does digital marketing,” or sporadically buying billboard placements for a month here and there, is unlikely to deliver results.
  • Viewing a marketing program as “nice to have” rather than must-have. Let’s be frank. If your senior leadership views marketing as an expense that they grudgingly pay for, their fear of spending money on something they’re skeptical about will turn into a self-fulfilling prophecy. When business is good, a consistent marketing effort maintains success, but it’s even more important during growth periods and challenging times. For example, when revenue drops due to competition, marketing is more essential than ever. Viewing your marketing budget as the first place to cut when the practice budget gets tight will undermine your efforts to turn the situation around.

You can avoid these and other costly marketing mistakes by making sure a marketing budget is among the basic components of an overall business strategy built around your goals. This ensures that funds will be available to fuel the activities needed to help you achieve your goals.

But what’s the magic formula for the right marketing budget?

Determining an appropriate marketing budget is a struggle for most physician practices. They may feel even more confused when they realize there isn’t a single, correct answer. It isn’t a matter of ambiguity: it’s a matter of having several intelligent approaches to choose from. Here’s a quick review some of the most common approaches.

  • Percentage of expected (or targeted) sales. The percentage of sales approach has evolved as organizations have accumulated knowledge and experience about how different percentages of marketing investment affect revenue-generation. Viable marketing budgets can range from 1 percent of collected revenue to 10 percent and more, depending on various factors such as how well-established your business is and how ambitious your growth targets are. In healthcare, thought leaders such as John Deutsch have pointed to a typical range of 2–5 percent (Deutsch, 2011). That said, specific circumstances, such as operating in a large metropolitan area with a costly media market, could raise the percentage substantially.
  • Patient acquisition cost (PAC) budgeting. Assessing the cost of acquiring each new patient is another way to formulate a marketing budget. Take the number of new patients you gained last year and divide it into the amount you invested in marketing. The result is your PAC, which you can then use to calculate a marketing budget. Allowing for patient attrition, determine the number of new patients you need to attract in the coming year to meet your revenue budget, then multiply that number by your PAC.
  • Goal-based budgeting. In this approach, you begin with a list of what you want to accomplish, then build out a list of strategies and tactics that will support those goals. The estimated cost of the strategies and tactics is your marketing budget. If the resulting number is beyond what you have available to invest, it may be necessary to consider adjusting the goals based on what you can adequately support through marketing.
  • Sales-support budgeting. If your practice depends primarily on referrals, you may have a team of marketing representatives or physician liaisons. Like any sales team, these professionals are charged with bringing new customers into your pipeline and maximizing the value of existing relationships. In a sales-support approach, a marketing budget is driven by the cost of tools and resources the sales team needs to “meet their numbers,” in terms of revenue or volume. Support for a medical practice marketing team includes (1) identifying new referral sources or opportunities to grow existing relationships, (2) increasing demand by educating referring offices about services and differentiators, and (3) equipping the team with resources ranging from a customer relationship management (CRM) tool to marketing collateral that reinforces sales efforts.

What approach to a marketing budget is best for you?

Ultimately, it comes down to your business situation and even your subjective preferences. There isn’t one right answer, but the above list gives you at least four smart choices. Each may fit the realities of your business in unique ways. Goal-based budgeting has the strength of directly correlating your budget with your goals for the year. Sales-support budgeting is grounded in an assessment of what your team needs to succeed. Budgeting by percentage of expected revenue helps you evaluate your marketing investment in the context of how aggressive your revenue goals are for the year.

As you consider these alternatives, one may well rise to the surface as the best fit. But if the choice still seems perplexing, consider the fresh perspective and clarity that an outside expert can provide, especially one with experience in medical practice marketing that has guided practices away from their “seat-of-the-pants approach” to strategy-fueled success.

Works Cited

About the Author

Gail Schwartz has an extensive background in planning and executing strategic marketing and branding initiatives for entire healthcare organizations and specialty service lines. Her work has been recognized with Aster Awards, Healthcare Advertising Awards, and Quest Awards. Gail can be reached at (717) 852-7171 or

Welcome New Members

Our membership continues to grow! Take a look at the list of healthcare professionals and students who have recently joined NCMGMA (May 23, 2018 through June 26, 2018):


Mark Falls, Blue Ridge Pediatrics, Raleigh, NC
Michael Griffin, Beacon Prosthetics & Orthotics, Raleigh, NC
Darci Harvey, EmergeOrtho, PA, Hickory, NC
Laura Hill, Mt. Olive Family Medicine Center, Inc., Mount Olive, NC
Kenneth Johnson, Vidant Medical Group, Greenville, NC
Robert Martin, Atrium Health, Charlotte, NC
Nancy Pajdo, UNC Specialty Care at Sanford / UNCPN, Sanford, NC
Pamela Petersen, Baby + Company, Clayton, NC
Jackie Plemmons, The Family Health Centers, Asheville, NC
Jennifer Sheppard, Carolina Urology Partners, Huntersville, NC
Cindy Womble, Durham Women’s Clinic, Durham, NC


Kate Edwards, MSOC Health, Chapel Hill, NC
Zach O’Connell, Biz Technology Solutions, Inc., Mooresville, NC


Reagan Childers, Appalachian State University, Kings Mountain, NC
Gauri Joshi, University of North Carolina at Chapel Hill, Morrisville, NC


Director Positions Open on NCMGMA Board

Western Region Director and Eastern Region Director
Positions Open

NCMGMA Members: Nominations are being solicited from our Active and Affiliate members to serve on the NCMGMA Board of Directors. In accordance with our bylaws, there will be two (2) open positions on the Board of Directors as an at-large member beginning November 1st, which are both three (3) year terms. Candidates will only be accepted from the Western and Eastern regions to fill these vacancies.

NCMGMA regions are outlined in the map (PDF) found at the following link.

Any member from one of these regions may nominate another member from the region or themselves, however all nominees should complete a leadership profile for review by the Nominating Committee. The Nominating Committee will convene in August for the purpose of recommending a slate of candidates to the NCMGMA Board of Directors for approval by the membership at our next NCMGMA Business Meeting scheduled for Thursday, October 18th at 11:30am during the NCMGMA Fall Conference at the Marriott in Charleston, SC.

Please click this link to view a copy of our bylaws (PDF).

The NCMGMA Leadership Profile Form asks general questions, and asks for a personal letter of commitment and an employer letter of recommendation. Both letters are required and can be submitted through the online Leadership Profile Form or emailed to Please click on the Leadership Profile Form here to begin.

Nominations are due NO LATER than 5:00 pm on August 17th.

Remember! Only candidates from the Western and Eastern regions will be reviewed and considered.

The Nominating Committee appreciates all nominations received. However, the Committee may only be able to respond to those candidates it elects to recommend.

Sexual Harassment in the Workplace Webinar on July 17th


NCMGMA-NCMSF July Lunch & Learn Webinar
Sexual Harassment in the Workplace

July 17, 2018 | 12:00 PM – 1:00 PM
Sponsored by Medical Mutual


Make plans to join us on July 17th for our Lunch & Learn Webinar “Sexual Harassment in the Workplace,” lead by Parker Poe Adams & Bernstein attorney Patti Bartis. This program will focus on sexual harassment and review how to address and prevent it in the workplace.


patti-bartis130aPatti Bartis
Parker Poe Adams & Bernstein
Patti Bartis is an attorney in the Raleigh office of Parker Poe Adams & Bernstein. She has been practicing employment law for over 20 years. Patti and her firm represent medical practices of all varieties and sizes. Patti advises medical practices on compliance with employment laws and defends them in adversarial proceedings such as EEOC charges or lawsuits. She is a graduate of Bucknell University and the UNC School of Law.


This webinar is complimentary for NCMGMA members and $50 for non-members. Space is limited so make sure to register early! After you register, you will receive an emailed confirmation with webinar and phone-in instructions.

Click here to register

Continuing education credit may be granted through your professional organization (MGMA, PAHCOM, AHIMA, etc.). Please self-submit for these organizations.



For questions or more information please contact the NCMGMA offices at