The denial rates in DME billing are high, raising concerns about the reasons behind such increasing rates. Though documentation and coding are vital to avoid denials, there’s another factor that needs attention. The Standard Written Order (SWO) seems like a small document, but it has a huge impact on the administrative process.
A lot of times, denials don’t happen because the equipment was unnecessary. They happen because the documentation process is not done correctly. Mostly, DME providers overlook SWO, but they are the most crucial part of DME billing.
Seeing that a standard written order is vital, this blog aims to highlight the role of SWO as a key to efficient DME billing.
Decoding Standard Written Order: Learning the Basics
SWO is a written order that acts as a confirmation for insurance providers that durable medical equipment like wheelchairs, oxygen systems, or more was needed by the patient. It basically establishes medical necessity.
The right time to complete the standard written order is before the equipment gets delivered. There are some exceptions to this, in which SWO can also be completed after the delivery.
SWO is created by the healthcare provider who prescribes DME to any patient. DME providers are not the ones creating SWO. However, they do have to ensure that the written order is accurate.
In simple words, when a healthcare provider approves that the patient needs a specific DME, he/she creates a confirmation (SWO). It is later used by insurance providers who use it to verify medical necessity. Lack of SWO causes claim denials and rejections.
SWO Essentials: Things to Include
There are certain elements that every SWO includes. Denials happen when there are missing details or errors in a standard written order.
Let’s see the mandatory things to be included in SWO:
Patient Name
The name of the patient in SWO must be the same as that in the insurance policy.
Item Description
SWO must have details about the durable medical equipment that the patient needs.
Quantity
The written order must also have the number of items/equipment needed by the patient.
Healthcare Provider’s Name and Signature
SWO must have the name and must be signed by the healthcare provider who is treating the patient. It can be a manual signature or an electronic signature.
Order Date
The order must also include the date of issue, as this is important information for the insurance payers.
When it comes to checking SWO, insurance providers are very particular. They check every detail thoroughly and deny or reject the claim if information is missing or incorrect.
The Role of SWOs in DME Billing: Why are they so important?
SWO serves as evidence rather than merely a record. It is a sign that the healthcare provider and DME provider have followed the process and met compliance standards.
It is crucial for DME billing because it is a part of claim approvals, medical necessity verification, and compliance rules.
Claim Approval – No Denials
Without SWO, insurance payers cannot release revenue for the offered DME to the patients.
Medical Necessity – Needed for Verification
Under DME billing, prescribed equipment becomes eligible for reimbursement only when the patient needs it medically and not for convenience.
Compliance – Following Rules
Not having SWO means that the healthcare provider doesn’t follow the proper billing process. This can result in denials and uncalled-for audits.
SWO Mistakes That Lead to Denials: Finding the Root Cause
Mostly, manual errors like missing information and errors are the reason behind denials in the case of SWO.
Let’s go through the common causes behind denials due to SWO:
Incomplete Information
If you are missing some of the basic information, like the patient’s name, the prescribed equipment details, or the quantity needed by the patient. Then, this will result in denial.
Lack of Specific Equipment Description
Healthcare providers are supposed to mention the specific type of equipment needed by the patient. However, if you have not mentioned the exact details and mentioned something generic, it will result in denials.
Wrong Dates of Issue
We discussed earlier that the provider is supposed to mention the date of issue. If this information is not recorded correctly and there are missing or mismatched dates, it will result in denials.
Lack of Date and Signature
The healthcare provider is supposed to mention the date and sign for proof either manually or electronically. But when there is a lack of signature or date or both, the claims result in denials.
Ensuring that all these things are taken care of is difficult for healthcare providers, DEM providers, or healthcare practices. That’s why there are DME billing services that offer expert solutions to DME billing issues. They simplify the process and ensure that you maximize DME billing reimbursement without any trouble.
What Happens When There Is Poor SWO Management?
Mistakes and missing information don’t just cause claim denials; they also disrupt the revenue flow. It costs healthcare providers and prevents them from earning adequate remuneration for rendered medical assistance.
Reimbursement Delays
Once SWO has been mismanaged, it gets into the cycle of denials leading to potential reimbursement delays.
Increased AR days
Delays in reimbursement are the biggest reason behind increasing AR days. Unpaid claims slowly turn into AR days and then bad debts.
Denial Resolution
The process of denial resolution is time-consuming. It takes more time to fix errors; that is why avoiding denials due to improper SWO is a better idea.
Compliance Risks and Audits
If your practice is facing repeated SWO mistakes, it may lead insurance payers to look into the matter and initiate audits and penalties.
How Do DME Billing Services Simplify SWO?
Medical Billing Services is well aware of how to manage completing SWO. Here’s how they do it:
Thorough SWO Verification Before Submission
Medical billing companies ensure that they double-check everything before submitting SWO to insurance payers to avoid denials.
Coordination with Healthcare Providers
If the medical billing partner finds any errors or they are confused about something, they immediately coordinate with the healthcare provider and rectify the mistake.
Internal Documentation Audits
Medical billing services conduct internal audits to ensure that there are no errors at the time of actual SWO submissions.
Proper SWO Expertise
Professionals know all the details about SWO. They understand each and every requirement and reduce the scope of errors.
Use of Advanced Technology
Medical billing partners utilize technology to create accuracy checklists, to maintain EMR and workflow, and to monitor compliance. All this improves the administrative process and reduces errors that cause denials.
Final Thoughts – Choosing Expert Services
Standard written orders are extremely important for efficient DME billing. There are a lot of issues in achieving overall accuracy with SWO. However, with a medical billing partner by your side, you can improve your administrative process without any hassle.
Eminence RCM offers medical billing services in Delaware and other parts of the US. We know that you want to maximize DME billing reimbursement. Our team of billing experts makes sure every step is accurate, including SWO. We help reduce errors and keep everything compliant.
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