Standard Documentation Requirements - SWO

All claims submitted to Medicare must have specific documents to be considered a valid claim. Understanding the requirements, including what content is necessary, will support your overall claims acceptance/payment rate.

CMS created the “Standard Documentation Requirements for all Claims Submitted to DME MACs” Policy Article, A55426. This Policy Article provides a description of the necessary documents and includes the specific details needed in each document.

Per the Policy Article, all claims submitted to Medicare require a written order or prescription, which is referred to as the Standard Written Order (SWO) All SWOs must include the following elements:

• Patient’s Name
• Patient’s Medicare Beneficiary Identifier
• Order Date
• General Description of the Item Provided, which may be the HCPCS code or the brand name/model number
• Quantity to be delivered
• Treating Practitioner Name
• Treating Practitioner NPI Number
• Treating Practitioner Signature

The SWO may be created by the DMEPOS provider and then signed by the treating physician. You must have the SWO on file before submitting a claim to Medicare.

What Does This Mean for You?

Check your current SWOs and assure they have all the required elements. Read the Standard Documentation Policy Article. Click HERE for more information about Standard Written Orders.