News in brief - March 17, 2008

Medicare claims must now have an NPI

On March 1, Medicare began requiring physicians to use their national provider identifiers on electronic and paper claims. Medicare claims without an NPI will be rejected, said the Centers for Medicare & Medicaid Services. For now, physicians can use their old ID numbers along with their new NPIs on claims. Starting May 23, however, doctors must use their NPIs only. On that date, private payers also will require that doctors use only their NPIs on all electronic claims. Policies on physician IDs for paper claims vary by insurer.

CMS suggests that doctors, if they haven't done so already, immediately begin submitting a small number of Medicare claims using only their NPIs to test their ability to get paid under the new system. If successful, they should increase the number of NPI-only claims. Physicians whose claims are rejected even though they've used their NPIs should check their record in the National Plan and Provider Enumeration System to verify or update their registry record, CMS said. If the problem continues, they should call their Medicare contractor. More information is available online (www.cms.hhs.gov/NationalProvIdentStand).

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CMS sees steady health spending rise

National health expenditures are expected to show an increase of 6.7% for 2007 -- to $2.25 trillion -- and maintain that growth rate through 2017, says a Centers for Medicare & Medicaid Services analysis in last month's Health Affairs. Spending on doctors and clinical services increased 5.7% in 2007 to $424 billion, compared with a 5.9% rise in 2006, the report estimated. Spending on physicians is expected to go up similarly through 2017, assuming that scheduled cuts to Medicare updates for physicians occur. Existing law calls for severe cuts to Medicare pay, including a 10.6% reduction starting July 1, but in recent years Congress has prevented such cuts.

The report is available online (content.healthaffairs.org/cgi/content/abstract/hlthaff.27.2.w145v1).

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DEA develops e-prescribing rules

The Drug Enforcement Administration has indicated its intent to ease its ban on the electronic prescribing of controlled substances. The DEA has sent proposed rules on e-prescribing controlled substances to the Dept. of Justice and the Office of Management and Budget for review but cannot comment on them at this stage of development, said spokeswoman Rogene Waite. The administration will make any necessary changes before publishing the proposed regulations in the Federal Register, she said.

The Dept. of Justice has finished its review, Waite said. She could not comment on the department's response. The OMB received the rules on Feb. 13 and typically takes 90 days to go over them.

Sen. Sheldon Whitehouse (D, R.I.), who had prodded the DEA for the rules, called the news of their development encouraging. "With millions of Americans securely transmitting credit card and bank account information electronically, there's no reason a doctor shouldn't be able to prescribe Vicodin electronically," he said.

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ACP calls for more research on medical marijuana

In an effort to encourage expanded research into the potential therapeutic benefits of medical cannabis, the American College of Physicians in February released new policy asking the federal government to ease some restrictions. "Unfortunately, research expansion has been hindered by a complicated federal approval process, limited availability of research-grade marijuana and the debate over legalization," the policy report states.

The ACP said it supports programs and funding for rigorous scientific evaluation of medical marijuana use and publication of the findings. It also urges that marijuana be reclassified from a Schedule I controlled drug to a Schedule II or Schedule III. The organization supports exemption from federal criminal prosecution, civil liability or professional sanctioning for physicians who recommend or dispense medical marijuana in compliance with state laws.

AMA policy calls for further adequate, well-controlled studies of medical marijuana in patients who have serious conditions for which preclinical, anecdotal or controlled evidence suggests possible efficacy. It recommends that the drug be retained as a Schedule I substance pending the outcome of such studies.

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