Complying with Payer-Specific SWO Requirements in DME Billing

Complying with Payer-Specific SWO Requirements in DME Billing

Did you know?

The new Medicare guidelines went into effect on January 1, 2021. It is now necessary to communicate a Standard Written Order (SWO) to a supplier before charging any durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) items. Prior to the implementation of this new update requiring a SWO, a Detailed Written Order (DWO) was required. As a result of the CMS-1713 Final Rule, these new standards were renamed DWO to SWO.

Overview of Standard Written Order (SWO)

The SWO is an important document that serves as a prescription for DME and is required by Medicare and other insurance providers. It specifies the specific equipment, quantity, and period of use for each specified item. The SWO serves as proof that the DME supplier received a valid order from the treating healthcare provider. It assures appropriate documentation and aids in claim processing, lowering the chance of reimbursement denials or delays.

Importance of Correct SWO Documentation

It is critical for DME suppliers to have accurate and complete SWO documentation to reduce claim rejections and comply with payer rules. The SWO should include the patient's name, equipment description, date of order, prescribing provider information, and contact information for the supplier. The prescribing provider must ensure that the SWO is legible, signed, and dated. Any adjustments or amendments to the SWO must also be fully documented and signed.

Complying with Payer-Specific SWO Guidelines in DME Billing

Unless otherwise specified, the SWO can be completed by someone other than the practitioner. The treating practitioner must still evaluate and sign the SWO.

An SWO must include the following:

  • Name of the beneficiary or Medicare Beneficiary Identifier (MBI)
  • Order date
  • The item's general description, which includes:
  1. Description – A basic description, an HCPCS code, an HCPCS code narrative, or a brand name/model number are all acceptable.
  2. Equipment - All other ordered items, accessories, or additional features may be separately billed or require an upgraded code (list each separately).
  3. Supplies - All ordered supplies that are separately billed may be included in the DMEPOS order/prescription (list each separately).
  • Dispensed quantity
  • Name of the treating practitioner or National Provider Identifier (NPI)
  • Signature of the treating practitioner
Suppliers can create the SWO and submit it for signature to the physician. Prior to invoicing a claim to Medicare, the physician must provide a signed SWO. Since the SWO is not part of the medical record, all supporting medical paperwork must still be collected.

Signature Requirements for SWO:

  • Legible handwritten or electronic signature is the ONLY acceptable signature.
  • Stamped signatures are NOT acceptable.
  • Stamped dates are NOT acceptable.
  • A signature log is required for any illegible signature and must include the signer's PRINTED name, initials, signature, and credentials.
  • No signature on the SWO or medical record makes it INVALID

Face-to-Face (F2F) Requirements for SWO in DME Billing:

  • Must be documented in the medical record.
  • Include H&P, hospital discharge, or progress notes.
  • Supporting paperwork
  • Nursing notes
  • PT/OT notes
  • RT notes
  • Lab, x-ray, and blood work
NOTE: SWOs for refills can be written during the patient's annual health review and sent to the DME provider subsequently. However, the SWO is only valid for 12 months from the date it is issued.

Frequency is Still Required for an SWO

Supply items on an SWO still require frequency. Even though the new SWO guidelines eliminated frequency from the criteria list, Medicare will still review the medical records to confirm that the frequency being billed is supported.
  • Where should the frequency be included?
The frequency must be clearly stated on the SWO or medical records. Unfortunately, including frequency in medical records is not a regular practice for practitioners or physicians.

  • Why is frequency required while it is not on the SWO criteria list?

Medicare and third-party payers reimburse suppliers based on frequency. Medicare and Third-Party Payors want to know if the monthly supplies quantity is genuinely medically necessary. The quantity of items does not always equal the frequency, so they must see it on the SWO or their medical records.

  • Frequency and SWO

Overall, the new Medicare guidelines now require a SWO (rather than a DWO) before billing  DMEPOS items. Although the frequency is not mandatory in the SWO criteria, it must be mentioned. The frequency might be documented on the SWO or in the medical record.

Keep Up to Date on all DME Billing Changes

Implementing the Standard Written Order (SWO) process is critical for DME suppliers to optimize revenue cycle management and assure payer compliance. SWO documentation that is accurate decreases claim rejections and speeds up reimbursement. Outsourcing DME billing  to a professional medical billing company, such as 24/7 Medical Billing Services, ensures efficient billing operations and optimal revenue production. Stay ahead of the curve in the ever-changing healthcare industry by utilizing the power of SWO and collaborating with the team for your DME billing requirements.

See also: The ABCs Of DME Billing: A Checklist For Getting Paid