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Taking Steps Now to Determine Your HITECH Preparedness

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The American Recovery and Reinvestment Act of 2009 (ARRA) was signed into law in February 2009 by President Obama. The Stimulus or the Recovery Act, as the ARRA is also known as, was intended to promote investment and consumer spending and create jobs during the recession. Provisions of the Recovery Act include improving affordable health care, modernizing the United States’ infrastructure, furthering energy independence and relieving education costs, among other provisions.The Health Information Technology for Economic and Clinical Health Act or HITECH Act, is a section of the Recovery Act that allocates $19 billion for Health Information Technology (HIT) – which includes incentives for eligible professionals for the adoption and meaningful use of certified Electronic Health Record (EHR) technology. HITECH created three alternative incentive programs for EHR, including incentives for Medicare, Medicaid, and Medicare Advantage Organization. The Medicare incentive program offers eligible professionals incentive payments – eligible professionals are identified as doctors of medicine or osteopathy, doctors of dental surgery or medicine, doctors of podiatric medicine, doctors of optometry and chiropractors, who demonstrate the meaningful use of certified EHR technology. Hospital-based eligible professionals, however, do not qualify for incentive payments.Provisions for Medicare IncentiveMedicare incentives for eligible professionals are based on an amount not to exceed 75% of approximated allowed costs for covered services, subject to maximum yearly payment limits that vary by year and are based on the year in which incentive payments are first made. A summary of the maximum payments available to eligible professionals is shown below.Maximum Medicare Payments Available to Eligible ProfessionalsIf First Payment Year is 20112011 – $18,000
2012 – $12,000
2013 – $8,000
2014 – $4,000
2015 – $2,000
2016 – $0
2017 – $0
Total* – $44,000If First Payment Year is 20122012 – $18,000
2013 – $12,000
2014 – $8,000
2015 – $4,000
2016 – $2,000
2017 – $0
Total* – $44,000If First Payment Year is 20132013 – $15,000
2014 – $12,000
2015 – $8,000
2016 – $4,000
2017 – $0
Total* – $39,000If First Payment Year is 20142014 – $12,000
2015 – $8,000
2016 – $4,000
2017 – $0
Total* – $24,000Years After 20142015 – $0
2016 – $0
2017 – $0
Total* – $0*Excludes 10% bonus payments to health professional shortage area eligible professionals.Mandated under HITECH, adjustment provisions serve to decrease payments to eligible professionals in years after 2014 at a rate of 1% per year, subject to a maximum cutback of payments of 5% under the authority of the U.S. Secretary of Health and Human Services.Provisions for Medicaid IncentiveEven though eligible hospitals can collect both Medicare and Medicaid incentive payments, eligible professionals must choose one of the two programs. Medicaid program incentives are available to physicians, nurse practitioners, certified nurse mid-wives, physician assistants working in a federally qualified health center or rural health clinic, and dentists – hospital-based professionals are excluded from the program. Eligible professionals must meet minimum Medicaid patient volume percentages to qualify for the program incentive, with payments based on estimated allowed charges and capped at 85% of $25,000 in the first year and 85% of $10,000 in subsequent years.Meaningful Use of Certified EHR TechnologyThe Centers for Medicare and Medicaid Services (CMS) was mandated by Congress to define meaningful use of certified EHR technology and propose an outline of requirements and deadlines for implementation. Published on January 13, 2010 in the Federal Register, the proposed rule includes Stage 1 criteria – initial meaningful use criteria – that will be gradually updated in the future.Stage 1 criteria focuses on electronically capturing health information in coded format, using captured information to track key clinical conditions and communicating captured information for care coordination. Implementing clinical decision support tools to facilitate disease and medication management is also a main focus, as well as reporting clinical quality measures and public health information.CMS Stage 1 Criteria: Meaningful Use Objectives for Eligible Professionals by Health Outcomes Policy Priority – 1. Improve quality, safety, efficiency, and reduce health disparities
a. Use computerized provider order entry (CPOE)
b. Record demographics, such as preferred language, insurance type, gender, race, ethnicity, date of birth
c. Record and chart changes in vital signs, such as height, weight, blood pressure, body mass index, and growth
d. Generate list of patients by specific conditions to use for quality improvement, reduction of disparities, research and outreach
e. Implement drug-drug, drug-allergy, drug-formulary checks
f. Maintain an up-to-date problem list of current and active diagnoses
g. Maintain active medication list
h. Maintain active medication allergy list
i. Generate and transmit permissible prescriptions electronically
j. Record smoking status for patients 13 years old and older
k. Incorporate clinical lab test results into EHR as structured data
l. Check insurance eligibility electronically from public and private payers
m. Submit claims electronically to public and private payers
n. Report ambulatory quality measures to CMS or, in the case of Medicaid eligible professionals, the states
o. Implement five clinical decision support rules relevant to specialty or high clinical priority, including for diagnostic test ordering, along with the ability to track compliance with those rules
p. Send reminders to patients per patient preference for preventive/follow-up care2. Engage patients and families in their health care
a. Provide patients with an electronic copy of their health information (including diagnostic test results, problem list, medication lists, and allergies) upon request
b. Provide patients with timely electronic access to their health information (including diagnostic test results, problem list, medication lists, and allergies) within 96 hours of the information being available to the eligible professional
c. Provide clinical summaries to patients for each office visit3. Improve care coordination
a. Capability to exchange key clinical information among providers of care and patient-authorized entities electronically
b. Perform medication reconciliation at relevant encounters and each transition of care
c. Provide summary care record for each transition of care referral4. Improve population and public health
a. Capability to submit electronic data to immunization registries and actual submission where required and accepted
b. Capability to provide electronic syndromic surveillance data to public health agencies and actual transmission according to applicable law and practice5. Ensure adequate privacy and security protections for personal health information
a. Protect electronic health information created or maintained by EHR technology through the implementation of appropriate technical capabilitiesThe Centers for Medicare and Medicaid Services expect to release the proposed Stage 2 criteria by the end of 2011 and the proposed Stage 3 criteria by the end of 2013. CMS predicts that Stage 3 criteria will define goals that will be attainable by the end of the incentive programs. Payment years will decide which criteria will be used to judge whether an eligible professional is a meaningful user of certified EHR technology. A summary of the three stages of meaningful use by payment year is shown below.Staged Meaningful Use Criteria by Payment YearIf First Payment Year is 20112011 – Stage 1If First Payment Year is 20122011 – Stage 1
2012 – Stage 1If First Payment Year is 20132011 – Stage 2
2012 – Stage 1
2013 – Stage 1If First Payment Year is 20142011 – Stage 2
2012 – Stage 2
2013 – Stage 2
2014 – Stage 1Years After 20142011 – Stage 3
2012 – Stage 3
2013 – Stage 3
2014 – Stage 3
2015 – Stage 3As indicated above, eligible professionals are encouraged to adopt meaningful use criteria as soon as possible, as late attainment will require compliance with more complex Stage 2 and/or Stage 3 criteria and possible reduction in reimbursement for those who are not meaningful users by 2015.Documenting Meaningful Use of Certified EHR TechnologyEligible professionals are required to report meaningful use of certified EHR technology in the first payment year, during any continuous 90-day period within a calendar year, and the entire calendar year for the second, third, fourth, fifth, and sixth payment years. In order to qualify for payments in 2011, eligible professionals must attest to satisfaction of the preceding Stage 1 objectives during the reporting period, via a secured mechanism in a manner specified by CMS, for Medicare eligible professionals or the state of Medicaid eligible professionals. Medicaid eligible professionals must also meet the state’s additional CMS-approved criteria for meaningful use by way of a secure mechanism approved by CMS. The EHR reporting period must be determined and the eligible professional must provide the result of each applicable measure, for all patients seen during the EHR reporting period for which a selected measure is applicable. Additionally, the eligible professional must attest that certified EHR technology was used during the reporting period. If a Medicaid eligible professional has adopted, implemented, or upgraded certified EHR technology, the provider must demonstrate meaningful use in the second payment year.For payment years in 2012 and after, eligible professionals must attest to all items attested to in 2011 except that “report ambulatory quality measures to CMS or, in the case of Medicaid EPs, the states.” Eligible professionals should also electronically submit to CMS or the state for Medicaid EPs, clinical quality information in the approach specified by CMS.Certification CriteriaA qualified Electronic Health Record is one that includes certain basic requirements to identify the patient and provide medical history, supports physician order entry, has the capacity to furnish clinical decision support, captures and queries information as it relates to quality of care, and exchanges and integrates such information. Only a qualified EHR that has been tested and certified, in accordance with the certification program created by the national coordinator, is acceptable to become certified EHR technology. Certified EHR technology may be either a Complete EHR, which is a single system that has been developed to meet all applicable certification criteria adopted, or a group of EHR Modules that when combined, form an EHR capable of being certified.Certification standards for certified EHR technology are divided into four separate categories – Transport Standards, Content Exchange Standards, Vocabulary Standards and Privacy and Security Standards. Transport Standards constitute a universal and secure communication protocol among systems. Content Exchange Standards are used to share prescription information and clinical summaries, which have been adopted from a multitude of sources and existing standards. Vocabulary Standards establish uniform nomenclatures and codes used to describe clinical procedures, medications, allergies and other issues. Privacy and Security Standards set encryption and tracking requirements that certified EHR technology must meet, in addition to HIPAA’s requirements for securing electronic health information.The meaningful use objectives for eligible professionals and eligible hospitals in Stage 1, carry with it specific certification criteria to reinforce the achievement of the objectives. The ability to achieve the certification criteria is integral in a Complete EHR or EHR Module.How to Determine Your Meaningful Use PreparednessIn order to define the standard for achieving meaningful use, a thorough technical and cultural analysis must be performed. If an EHR is already in position, one must evaluate the currently implemented EHR system.EHRs that have already been certified by the Certification Committee for Healthcare Information Technology (CCHIT) – which presently serves as a recognized U.S. certification authority for EHR technology – likely embrace many of the clinically oriented capabilities necessary for certified EHRs under the Recovery Act. These previously CCHIT-certified EHRs are not expected to meet ARRA certification criteria, however, will be tested and certified as EHR Modules rather than Complete EHRs.Resources, like independent readiness assessment audits and scorecards, are available to assist with readiness assessment. These resources help define the methodology and strategy used in designing and implementing the EHR system, creating performance evaluation tools, sustaining a satisfactory level of performance, and addressing resource utilization and workflow challenges.Why Transition Now?Both the provider and patient benefit from early transition to achieving meaningful use of certified EHR technology. Providers will receive larger incentive payments, as available incentive payments decrease when Stage 1 criteria are adopted post-2012 and the complexity of the meaningful use definition will heighten as Stage 2 and Stage 3 criteria are implemented. Patients will benefit by receiving better quality and more efficient patient care and possible lower provider insurance premiums as malpractice suits reduce or diminish.

1 Pair of black CNC Extendable Adjustable Motorcycle Brake Clutch Levers Fit For Honda CB919 2002-2007

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Brand New Pair (Clutch and Brake) Levers set with 6 adjustable positions.
Economy priced levers produced for street use
Full adjustable and with an all-alloy construction. Levers are manufactured from billet 6061 T6 aluminum with hard anodized.
Precision Machined pivot bore to ensure a perfect fit. 6-position adjuster allows you to tailor your lever reach set-up easily for the most comfort gesture.
Direct replacement for stock levers. No modification! (Some parts or bushing from the original levers may be required to complete the installation)

Item Specific

Color:Black levers with red adjusters

Length:Short (about 1 inch shorter than the original)

Fitment:HONDA CB919 2002 2003 2004 2005 2006 2007

Quantity:1 pair
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Dee Zee | 100020 | GMC | C3500 Pickup | SIERRA, V8, 6.5 | Grille

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Dee Zee, Inc, based in Des Moines, Iowa, is celebrating over 28 years as a leading supplier of aftermarket truck accessories. Dee Zee announced their arrival with the introduction of 12 custom fit britetread or extruded aluminum running board applications at the 1977 Sema Show in Las Vegas. From that November to today, Dee Zeesâ mission is to market the highest quality truck products while satisfying the needs of their customers. Dee Zee has expanded the initial offering of 12 boards to over 120 running boards and accessories. Their product lines now boast over 80 different toolboxes, 20 tube products, 34 Mossy Oak® Break Up ⢠CAMO products, and 32 heavy-duty products. The various product lines account for over 2,000 total SKUâs.
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1995 Honda VFR 750 F Outer Clutch Basket

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1995 Honda VFR 750 F Outer Clutch Basket

The Outer Clutch Basket is turned by the engine crankshaft. When the clutch is operated, the fibers and steels form a friction connection to the Inner Clutch Basket, transferring power to the input shaft of the Transmission. The Condition of this part is Used.

A used Outer Clutch Basket will be complete and fully functional with no excessive wear. All “fingers” will be intact and undamaged, all teeth in good condition.

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71-6170 3-Point Hitch Mount Kit for Bombardier

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  • The 3-Point Hitch is standard category zero and is designed for the larger 4WD ATVs
  • With the mounting hardware in place, the hitch can be attached or removed in minutes
  • The electromechanical, screw-driven lift will give you years of clean, economical operation
  • Because the 3-point hitch locks out the ATV s suspension, it is able to penetrate the soil with control and precision
  • A built-in float was added to provide smooth operation of the implements in the ground
  • Cycle Country has designed a universal three-point main frame that combines with a model-specific mounting kit
    This product can be used with
  • Bombardier 500 Traxter 4×4 2005
  • Bombardier 650 Traxter XT CVT 4×4 2005Read More..

1991 Suzuki GSF 400 Bandit Left Or Rear Head Intake Camshaft

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1991 Suzuki GSF 400 Bandit Left Or Rear Head Intake Camshaft

The Intake Camshaft operates the Intake Valves in the Head. On bikes with multiple Cylinder Heads, this is the Intake Cam on the Left or Rear Head (as you are sitting on the bike). The Condition of this part is Used.

A used Camshaft will be straight and true, showing no excessive wear. All contact surfaces will be within manufacturer specifications. Timing sprocket is included.

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Why Law Firm Billing and Trust Account Systems Must Work in Tandem

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Choosing Legal-Specific Billing Software
Law firms typically require legal-specific billing programs to handle a variety of client billing arrangements, such as hourly, fixed and contingency fees. However, law firms often select a billing system without adequately analyzing their trust bookkeeping requirements. While attorneys understand the importance of complying with stringent trust account bookkeeping rules, they frequently do not grasp that many billing and trust activities function like a bicycle built for two and are best managed in an integrated fashion.Because legal billing practices come under purview of state ethics departments, it is equally crucial that billing and trust accounting software help you comply with regulations.Law Firm Billing and Trust Accounting are Interrelated
A standard practice for most law firms is collecting advanced client payments (retainers) for services. In general, states have strict accounting rules that require attorneys to deposit unbilled/unearned client funds in trust accounts.If an attorney expects to use advanced funds quickly and the specification is in the client engagement letter, state rules may permit deposit of retainers in a regular operating accounts. The rule of thumb is strict adherence to states’ professional and ethical rules pertaining to client funds. Failure to abide by the rules and maintain proper trust and operating account bookkeeping could result in administrative, civil or criminal sanctions.If your law firm accepts and deposits client retainers in trust accounts until charging the funds to invoices and transferring them to an operating account, it is important to ensure your billing system also meets all your trust accounting needs.Keeping Track of Retainer Balances
First and foremost, whether you deposit retainers in trust or operating accounts, you must always know a client’s retainer balance. Remember, retainers are client funds, not your funds.With each invoice, apart from the amount billed, you will need to supply retainer balance information. Once you generate an invoice, you might apply retainer balances to pay off the invoices.If the retainer is in a trust account, you must:

Issue a trust check payable to the law firm for the invoiced amount.
Make a deposit in your firm’s operating account.
Apply the deposit to the invoice and mark the invoice paid.
Update the client’s retainer balance and unpaid balance, when retainer funds are used to pay invoices.
If the retainer is an operating account, you must:

Apply funds received and previously deposited in the operating account toward invoices and mark invoices paid.
Update the client’s retainer balance and unpaid balance as retainer funds are applied and invoices marked as paid.
Missing a Critical Step Throws Your Billing and Trust Accounting Out of Sync
If you fail to complete any of the above steps in your ledger or bank account, your system will be out of sync. For example, if you applied a trust retainer to an invoice, but forgot to write a check in the trust bookkeeping system, the result will be an invoice marked paid, but funds not drawn from client trust account. Numerous combinations of this sort are possible and each mistake will result in severe administrative headaches.Maintaining a 360 Degree View
While working on a legal matter, it’s nice to know current retainer balances. In fact, it’s beneficial to know the client balances for each of the following at all times:

Unbilled Balance: The total dollar value of the time and expense cards recorded, but not billed.
Unpaid Balance: The total amount you have billed the client, but that has not yet been paid.
Operating Retainer Balance: Client retainer balance in the operating account.
Trust Retainer Balance: Client retainer balance in a trust account.
The above balances are interconnected and you must update them simultaneously. When you convert time/expense cards to invoices, the unbilled balance goes down and unpaid balance goes up. Likewise, when your office pays invoices from retainer balances, the unpaid balance goes down and the retainer balance goes down.Knowing these balances at all times gives you a 360 degree view and puts you in much better control. Here’s how:

If the unbilled balance exceeds your comfort zone, you can invoice immediately rather than waiting until your next scheduled billing date.
If unpaid balances are rising, start sending payment reminder letters along with overdue invoices.
If retainer balances are available, invoices are unpaid and your engagement letter allows you to apply retainers, you can quickly pay off those invoices.
Typical Billing & Trust Account Scenario
Here is a simplified example of how to handle the retainer for a legal matter and its corresponding trust account.1. On January 1, you opened a new case with a $5000 initial retainer and deposited it in your attorney trust account. Your trust books must reflect client balance of $5000.2. In the month of January, you recorded $2700 in time/expenses charged to the matter. On January 31, your books must show the matter’s unbilled balance as $2700 and retainer balance as $5000.3. On February 1, you generated an invoice converting unbilled time/expenses to billed status. Your books must reflect the matter’s unbilled balance as $0, unpaid balance as $2700 and retainer balance as $5000.4. On February 1, you paid the invoice from the retainer balance. Then, your books must reflect the matter’s unbilled balance as $0, unpaid balance as $0 and retainer balance as $2300. You will make a bank deposit with $2300 trust check to your operating account, which your accounting ledger must reflect.Even this simplified, but practical illustration shows how law firms billing and trust activities are closely interrelated.Like Invoices, Retainers Aren’t One Time Event
Most law firms send reminder notices for aging invoices (if you don’t send late payment reminders, numerous studies suggest your chances of getting paid fall exponentially with rising invoice aging). It is also common for a good billing system to automatically prepare batch reminder notices for all overdue invoices and print your choice of cover letter.Retainers are in the same league with invoices and late payment reminders, and are not just a one-time event. However, law firms often forget to ask for replenishments, when retainer balances fall below a required amount. If your engagement letter requires a client to maintain a specified retainer balance, you must ask for “replenishments.”Just like periodic invoice reminders, it is highly recommended law firms make it a practice to generate retainer replenishment demand letters. Chances of a client coming in on their own and handing out additional advances are not very high!Trust Bookkeeping Safeguards are a “Must Have”
While you weigh the advantages of an integrated billing-trust account system, do not forget that it’s not enough for the system to track retainer funds in trust accounts. Trust funds are strictly client funds; they follow special accounting rules. The same system must also provide required trust bookkeeping safeguards.Trust accounting is fundamentally a different bookkeeping concept and must be able to:
Support monthly bank statement reconciliation.
Produce three-way reconciliation statements (tie book with bank with individual ledger card balances.
General ledger balances with details about the portion of funds that have cleared/not cleared the bank.
Prevent common trust bookkeeping mistakes from occurring such as ledger card overdraft, co-mingling with other ledger cards, duplicate check numbers, etc.
Print checks, deposit slips etc.
Benefits of a Billing and Trust Accounting System That Work in Tandem
Your firm will reap strong benefits with accounting software that blends trust account bookkeeping with your time-tracking and billing system. Not only will you improve back office efficiency, you’ll spend less time on billing management and have more hours available for casework. Built in system safeguards ensure trust account compliance with state regulations and give you peace of mind. Last, but not least, when billing and trust accounting systems work in tandem, you’ll increase profits and improve your firm’s financial picture.Easy Soft to the Rescue
For technology at its best, try Easy Soft’s fully integrated billing and trust accounting software combo. Easy TimeBill software with the add-on Easy Trust module is an easy to use program that captures all billable hours/expenses, generates bills, receives payments and maintains trust books in compliance with state requirements. Learn more. Contact: 800-905-7638 or visit us online at: http://www.easysoft-usa.com.