The difference between internal marketing and external marketing
Internal marketing refers to the process of making employees appreciate the products of their employer company. It involves employee satisfaction and the feeling of ownership towards the organization, (Groonroos, 119). For example, motivational talks and leading by example by team leaders, special appreciation for top performers and friendly working environments. External marketing refers to the process of selling the products to the outer world. It involves advertising, sampling and getting customers to make some purchases. Examples include selling of a medical plan to a client, advertising the services of a healthcare provider to the potential clients and referrals of new clients by existing clients
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All strategic plans attempt to answer the following three questions
Where are we now?
This defines the position of an organization in terms of its internal and external environmental analysis. It also involves an assessment of its competitive position in the market place known as a SWOT analysis.
Where do we want to go?
This is what the organization hopes to achieve. It is answered by formulation of goals and objectives and a mission statement. The formulation is based on the results of the situation analysis performed earlier; in answering the first question.
How are we going to get there?
This describes the means that will be used to achieve the goals and objectives, and to accomplish the mission defined in the mission statement. (Allison and Kaye 25)
Fraud is an intentional and willful act of deception or misrepresentation made by an individual who knows the information is false and could result in an unauthorized reimbursement to a practice.
Abuse is defined as improper acts or incidences that are unintentional, but inconsistent with standard practices. It happens when practices do not follow proper coding and billing guidelines, (Report Fraud and Abuse 1).
Examples of Fraud and Abuse
- Billing for services/supplies that were not provided OR that do not meet the medically necessary criteria for billing. This is classified as false claims.
- Unbundling refers to coding components of a procedure separately when only a single code is necessary. This means that one procedure is regarded as a number of different procedures.
- Up-coding which is coding and billing for a level of service that is not supported by the medical record documentation for higher reimbursement.
- Submitting duplicate claims to receive additional money; this, results to an individual getting double reimbursement for the same claim.
- Scheduling patients for multiple visits to receive higher reimbursement.
A medical practice can safeguard itself from potential Fraud and Abuse issues by
- Use of Internal Chart Audits.
- Good documentation of all procedures and activities.
- Understanding how its billing/coding patterns and utilization compare to others.
- Educating all staff, including MDs on billing and coding.
- Staying current with all fraud & abuse laws.
- Putting a Corporate Compliance Program into place.
Elements of a Corporate Compliance Program
- Written policies, procedures, and standards of conduct are easily referenced.
- Designation of a compliance officer will ensure that all issues regarding corporate compliance are handled with expertise.
- Training and education-All staff should be equipped with knowledge regarding compliance issues and any other issues regarding their conduct at the place of work.
- Effective lines of communication throughout the organization should be clearly defined and made known to all staff.
- Enforcement procedures should be designed that will see to it that all regulations regarding conduct have been followed.
- Procedures for effective internal monitoring and auditing should also be defined. These will help detect any cases of abuse or fraud in their earliest stages.
- Procedures for corrective action should be put in place so that rectification of erroneous incidences is swift and smooth, (Bateson 176).
- Fraud and abuse plan must be in place. This will ensure that all cases of fraud or abuse are dealt with.
Bateson, John. Managing Services Marketing, Fort Worth: Dryden press, 1995. Print.
Groonroos, Christian. Service, Management and Marketing, Lexington MA Lexington Books, 1990. Print.
Allison, Michael and Kaye, Jude. Strategic Planning for Nonprofit Organizations, Second Edition, John Wiley and Sons, 2005. Print.
Report Fraud and Abuse. Web.