Extent of Billings by Nonpsychiatric Specialty Physicians for Mental Health Services Under CHAMPUS

A Senator requested an indepth study of the state of the art of financing for mental health services provided by four categories of providers. After it had been determined that nonpsychiatric specialty physicians, those physicians with specialties other than psychiatry, were providing 30 to 50 percent of all mental health services, GAO agreed to focus its work on identifying the extent to which those physicians were billing for mental health services. It also agreed to concentrate on the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS).

An analysis of mental health billings processed for CHAMPUS during 3 months in late 1978 showed that nonpsychiatric specialty physicians provided an estimated 4.3 percent of the total mental health services billed; they may be providing addditional mental health services, but not billing them as such. Often, when a mental disorder diagnosis was given, the service billed was an office visit. CHAMPUS beneficiaries receiving mental health services from nonpsychiatric specialty physicians were generally treated for a short time. Most patients received services in metropolitan areas, where it might be expected that mental health specialists are practicing. GAO had reservations about the accuracy and completeness of some of the statistical data because of the CHAMPUS inability to extract all of the billing information from its computer tapes. The overall data extracted from the computer tapes had to be adjusted due to many coding errors made by contractors processing claims for CHAMPUS. Both the American Medical Association and the American Psychiatric Association (APA) supported nonpsychiatric specialty physicians providing mental health services, because these physicians are often in the best position to diagnose and treat mental problems at an early stage. Because nonpsychiatric specialty physicians lack special training in treating seriously ill mental patients, APA officials had reservations about their treating such patients.