O&P Insight

Our goal is to help O&P businesses thrive. We provide comprehensive consulting solutions for O&P businesses.

We offer services in Workflow, Revenue Cycle Management, Staff Development, Practice Management, Clinical, Compliance, and more.

12/22/2025

🚨Top five things for professionals to know as we head into 2026:

💠 Changes to Medicare's accreditation process will require suppliers to be reaccredited and resurveyed annually instead of every 3 years beginning in 2026.

💠Enrollment accuracy is more important than ever. Clerical errors can now result in retroactive revocations. Review PECOS today to ensure all information is current/accurate.

💠Don't implement the new Knee Orthosis language too soon. The new coverage doesn't go into effect until January 26, 2026. Application of new coverage to current dates of service will likely result in claim denials.

💠January is the perfect time to schedule HIPAA and Fraud/Waste/Abuse training for staff.

💠Review/update payer fee schedules for 2026. May EMR software programs will do it for you, but some may have to be manually updated.

Stay proactive to set your practice up for success in 2026! 💯

12/19/2025

In October, the OIG identified improper payments for DMEPOS delivered to patients during inpatient stays. As of December, CGS and Noridian have begun issuing recoupments and adjustments for these overpayments—some dating back to 2018.

What should you do?
✔ If the claim was truly paid in error: Submit a refund
✔ If you believe the claim was recouped in error: Submit an appeal with supporting documentation
✔ Review internal processes to prevent inappropriate claim payments

Review here: https://bit.ly/44uuUb2

12/18/2025

Join us at the Amputee Coalition 40th Anniversary National Conference in Las Vegas from January 13–15, 2026!

Lesleigh Sisson, CFo, CFm will join a panel discussion on January 15th called Getting the Care You Deserve: Making Sense of Insurance Coverage. This session will share best practices, tips, and strategies to help you understand your insurance options and advocate for the coverage you need.

Learn more about the event and register here: https://bit.ly/48VuawV

12/17/2025

CMS has finalized a rule that changes how accreditation will work for suppliers in the new year.

Starting in 2026:
➕Re-accreditation will now be required every year, not every three years.
➕CMS will increase oversight of the eight accrediting organizations to strengthen compliance and reduce fraud, waste, and abuse.

Why it matters: Annual reviews help ensure suppliers maintain high standards of care and meet evolving regulatory requirements. This change is designed to protect patients and improve program integrity.

Learn more about the full rule: https://bit.ly/4oMVJ1d

12/16/2025

➡️Effective December 2, 2025, CMS has ended its approval of the Board of Certification/Accreditation, International (BOC) as an accrediting organization for DMEPOS suppliers.

Suppliers who need initial accreditation or are due for reaccreditation must now obtain accreditation from a CMS-approved accrediting organization.

For additional details, please visit the CMS website or check out this FAQ: https://bit.ly/4s2bUKO

12/15/2025

📢 Important Update: CMS Final Rule CMS‑1828‑F for Medicare 2026

Last week, CMS finalized the CMS‑1828‑F rule, introducing changes to the Medicare program effective January 1, 2026.

Here's the latest on Supplier Enrollment:

CMS now has expanded authority to retroactively revoke or deactivate a supplier’s PTAN, even for administrative oversights like unreported changes of ownership or address—previously reserved only for serious violations.

Additionally, The CMS‑855S application must now include a signed liability insurance certificate by the listed “authorized official."

Learn more and review all four updates here: https://bit.ly/4oMVJ1d

12/11/2025

We're sharing a recent development for providers and patients: Medicare has finalized changes to its Knee Orthosis LCD and Policy Article.

Starting January 25, 2026, new policy language will expand coverage for certain knee orthoses for individuals diagnosed with tibofemoral osteoarthritis—this time, without requiring objective joint laxity testing.

🔗 Full details are available here: https://med.noridianmedicare.com/web/jddme/policies/dmd-articles/2025/knee-orthoses-final-lcd-and-rtc-article-published

12/01/2025

📢 Avoid Timely Appeal Denials!
Stay on top of deadlines by using the Appeal Calculators available on the Noridian and CGS websites. These tools make it easy to calculate your appeal time limits and prevent costly mistakes.

✅ Noridian: Appeals Timeliness Calculator – JD DME
✅ CGS: Appeals Time Limit Calculator

✔ Bookmark these resources and keep your appeals on track!

11/25/2025

Q4 Topics to Thrive Webinar ✨
One of our favorite traditions—both for our team and our clients!

This session is your year-in-review for O&P:
✅ Key updates from the past year
🔮 A peek into the crystal ball for what’s ahead
💬 Open discussion on where we’ve been and where we’re headed
📅 Join us for an engaging conversation that sets the tone for the coming year!

Register here: https://bit.ly/4iuoRsM

11/21/2025

Stay informed on the latest changes impacting the O&P community as we close out 2025 and prepare for the New Year. Join us December 4 at 8:30am PST to hear from Michelle Wullstein, CPCO.

This 1-hour session will cover:
✔ Coding & Policy Updates
✔ Industry Trends
✔ Upcoming Events
✔ Q&A + Resources

Register today: https://bit.ly/4pqD7Fa

11/20/2025

Throwing it back to some sunny summer moments! Check out our O&P Insight swag out in the wild with our friends at Coastal Prosthetics and Orthotics .

We love seeing our gear on the move! Where has your Insight merch traveled? Let us know in the comments! 👇

11/20/2025

Regular WIP (Work-in-Progress) meetings are key to staying on track and avoiding costly delays.

We understand the challenges associated with billing for orthotics and prosthetics. That’s why we provide the tools and strategies you need to help your team streamline processes, improve communication, and keep reimbursement moving forward.

Ready to optimize your workflow? Explore our solutions here: https://bit.ly/3MbhABK

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