Apple denies French government’s ‘abusive commercial practices’ accusation

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Apple has responded to accusations by the French government that it is taking advantage of the country’s developers, dismissing claims of ‘abusive commercial practices’ by highlighting the funds paid to the nation’s iOS app developers and the support it provides to both application producers and their users.
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Apple touts developer success in response to allegations of ‘abusive trade practices’ in France

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It was reported yesterday that the French government is taking both Apple and Google to court over alleged “abusive trade practices.” Specifically, the government claims that neither Apple nor Google treat their developers fairly, citing factors such as non-negotiable commissions and contract terms.

Today, both Google and Apple have commented on the accusations made by French Finance Minister Bruno Le Maire…



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What Happens When you Ignore Basic Business Practices?

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The unfortunate reality is that the majority of claim dollars lost to medical practices are from “self-inflicted injuries”.  While it may feel good to blame the insurance carrier or health plan and their bureaucratic, Byzantine rules, the fact is that physicians and their staff must come to grips with the reality that most of the dollars lost are through a lack of establishing proper management of their own revenue cycle, and most often, because of a decision to disregard basic business practices and payer rules.

Do you want to complain about the rules and not get paid?

Or have the money in your pocket and then complain?

Most claims dollars are lost due to:

  • Failure to identify the patient’s economic obligation before service is rendered to collect payment or guarantee payment before care is rendered.
  • Failure to submit claims in a timely manner
  • Failure to monitor the explanation of payments to identify denials or payment errors
  • Failure to resubmit initially denied claims in a timely manner with the correct information
  • Failure to appeal errors or denials in a timely manner

In reality, the failure is the physician’s, a failure to manage the revenue cycle of their practice.  It is a failure that costs big.

To eliminate the barriers that keep you from promptly receiving your hard earned money, you must make a commitment to learning how to win, and accept the responsibility for continual vigilance.  By doing so you can hold payers accountable for their performance, and in the process, achieve the funds you have legitimately earned. The reporting and other rules that have intrinsically been linked to EHR systems have been a major hindrance for small practices. Time is a precious resource, and physicians can’t always find time to fill out new reports

Payers set their own claim rules and timely filing deadlines.  They do so under their participation contract with you.  The rules are generally not spelled out in the contract, but in the payer’s “Provider Manual”, or in updates to that manual. Your contract with the payer generally includes a provision that gives them the right to issue new rules and policies and obligates you to their acceptance. Keeping up with the updates is necessary, as opportunities are missed for increased reimbursement, and plan specific rules not learned, cause an increase in denials. EHR platforms come with online scheduling, automatic bill pay and a number of other helpful tools that are beneficial to both physicians and patients.

Nearly all payers now have websites with the payer’s policies posted.  A posting is considered “notice” and the change is binding upon you.

Administrators and office managers benefiting from EHR adoption. Building schedules are simplified which reduces the number of missed appointments. Similarly, working with patients to address unpaid or outstanding bills is also more effective.

Even if you never received a provider manual, you cannot escape its obligations.  There is generally a little clause in your contract obligating you to its provisions.   If you can’t find the player’s manual, or if you are not getting the payer updates, call the plan and get a copy of the manual and get on their policy changes distribution list NOW.

Many plans now provide email alerts as to policy changes, which will automatically send you an email about payer policy changes. When combined with better clinical capacities and improved daily workflows, the benefits of EHR adoption create a portfolio of ways to improve a small practice.

Similarly, the payer’s posting of a new policy on a payer’s web site or publishing in their policy guide a policy change is binding upon you, and it could cost you.  You will need to have staff review the payer’s website on a regular basis to watch for new postings that impact your practice.

Regardless of the unreasonableness of the rules health plans create; they bind you under “contract law”.  Contract law legalizes the obligations accepted by two or more parties in a voluntary agreement.  Since the health plan wrote the contract, do you really think those terms and conditions are for your benefit or protection?  Unless the provisions of the contract conflict with state, Federal or local law or policy, you are bound to them, and the payer can enforce its contract terms.  You voluntarily entered into the agreement with the payer.  Whether or not you believe you had a choice, given the size of the payer’s market share, or what employers they insure, there is no law that obligates you to participate with any payer, therefore the relationship is voluntary. Fighting contract provisions is generally a costly and losing proposition.

So strong is the power of contract law, that the regulators have stated that they are not prepared to sit in judgment on the adequacy of documentation as to timely filing, stating “This gives rise to a question of fact which is beyond the jurisdiction of this administrative agency to resolve.  Questions of fact can only be decided in a court of law.”

More importantly, do you want to fight, or do you want to get your money?

Time is money is the old, overused adage, and in the case of claims, it’s your money.  This is where falling for the inbred excuses within the provider community comes back to haunt you.  It’s too confusing, they deny whatever they want, you can’t fight them, it’s not worth the time. Your practice needs to work its claims and receivables without allowing any time lags in getting your claim out the door, tracking its payment, appealing denials, and verifying the correctness of payment.

Vigilance is a responsibility that must be accepted by the physician and the staff.  For only by asserting your rights and knowledge of the rules, can an office protect its income and its money?  This requires an understanding of explanation of benefits/explanation of payments (EOB/EOP), as well as watching for notices of policies and changes that relate to claims.

Managing your revenue cycle means making sure that your claims process follows a process designed for your benefit, not just what is allowable by the payer.  One that always puts you in the position to press the payer for payment, using your state’s regulations as a club. That is if your state requires the payer to pay within 30 days of an electronic submission, hold them to that requirement.  Get your claims, electronically daily, and every day identify with the payer’s website any claims not paid on day 35.  If not listed, then re-submit, if listed, check where it is in the process.  If not set to be paid to you, file a complaint with your regulator of the payer.  If you have the process tight, you will have improved your cash flow, and ended the leakage of your dollars.

The blame game has no place in the operation of a medical practice, a medical business.  Blame is an easy way to dodge responsibility for an issue, a problem.

Too often practices fall into the trap of blaming the payers for everything, and in the process, ignore what should be their own responsibility and hide that responsibility from the physician.

The post What Happens When you Ignore Basic Business Practices? appeared first on ReadWrite.


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France Will Fine Apple and Google for ‘Abusive Business Practices’

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France is preparing to slap American tech giants Apple and Google with hefty fines as a result of “abusive business practices” according to reports. On Wednesday, the French Government confirmed that it is drawing up plans to take the two American tech firms to court for allegedly violating European commercial and trade laws. In an […]
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France plans to take Apple and Google to court over ‘abusive commercial practices’

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The French government will be taking legal action against Apple and Google for alleged "abusive commercial practices," France’s finance minister has declared, accusing the tech firms of taking advantage of the country’s app developers with unfair contracts and unjust app store pricing schemes.
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France to sue Apple and Google over ‘abusive’ developer practices

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France is taking Google and Apple to court over "abusive" app developer practices and could impose millions of euros in penalties. Finance Minister Bruno Le Maire told RTL that the government has a problem with the onerous conditions the tech giants…
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France taking Apple & Google to court for ‘abusive trade practices’ with developers

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The French government is taking both Apple and Google to court, accusing the companies of ‘abusive trade practices’ in the way that they treat developers.

Reporting on the case is light on detail, but France appears to have three objections to the way the relationship works between app stores and developers …



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Apple to Launch Medical Practices to Treat Its Own Employees

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What if your employer was really invested in your health? I don’t mean just providing you with insurance. I mean operating the clinic itself.

Well, Apple employees will soon find out: the company plans to launch new medical practices, named AC Wellness, to treat Apple employees in spring 2018, CNBC reports. The company will start with two clinics in Santa Clara County, California, near its headquarters in Cupertino.

“AC Wellness is an independent medical practice dedicated to delivering compassionate, effective healthcare to the Apple employee population,” according to the AC Wellness homepage.

There are already numerous job listings for an acute care physician, primary care physician, exercise coach, nurse coordinator, and more. According to CNBC, Apple is also looking for “designers” to create programs focused on preventing disease and promoting healthy behavior. Furthermore, the clinics will serve as a testing ground for various health-related products and services.

Homepage for Apple's AC Wellness. Image Credit: AC Wellness
Homepage for Apple’s AC Wellness. Image Credit: AC Wellness.

Apple isn’t the first company to try its hand at healthcare — last month Amazon announced that it intends to create a healthcare company of its own with Berkshire Hathaway and JPMorgan Chase. Amazon, however, hasn’t announced when its company will go live, so chances are Apple’s initiative will open first.

The two corporate giants’ moves towards commandeering their employees’ healthcare bring the future of the U.S. healthcare landscape into question. Companies already exert a modicum of control over their employees’ healthcare options and other benefits, and companies like Google have begun adding on-site wellness centers, physicians, and chiropractors for their workers.

Companies don’t do this out of the goodness of their hearts. Health issues cause 69 million workers to skip work each year, reducing economic output by $ 260 billion per year, according to the Centers for Disease Control and Prevention (CDC). Healthier employees also cost less in the long run because their insurance is cheaper. In short, lower healthcare costs equals higher profits.

So all these benefits, this new corporate obsession with subsidizing healthcare? It’s employers looking out for their bottom line.

So far, none of the reports have discussed the potential privacy issues that may arise from an employer that operates the clinic where an employee seeks care. There are strict laws governing patient privacy, which Apple will have to be sure not to violate as it both employs and treats people.

Amazon and Apple don’t have their own healthcare companies up and running just yet, so we can only speculate. Hopefully their moves might change employee health benefits for the better.

The post Apple to Launch Medical Practices to Treat Its Own Employees appeared first on Futurism.


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Qualcomm fined €997 million for anticompetitive practices (again) by the EU

The European Commission has fined chipmaker Qualcomm €997 million ($ 1.24 billion) for abusing its market dominance in LTE baseband chipsets. The decision comes as the result of an investigation covering the period from 2011 to 2016, during which Qualcomm paid Apple to exclusively use its LTE chips in iPhones and iPads.

“Qualcomm illegally shut out rivals from the market for LTE baseband chipsets for over five years, thereby cementing its market dominance.

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Apple Music, Beats under legal attack over third-party licensing practices

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A musician apparently disgruntled at how Beats Music and Apple Music has handled its streaming obligations is looking to fire up a class action suit, and is accusing Apple of intentionally deleting records and under-counting downloads and streams in order to pay artists less — or not at all.
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