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.

01/16/2026

We’re grateful for an incredible few days in Las Vegas connecting with the limb loss and limb difference community at the Amputee Coalition’s 40th Anniversary National Conference.

O&P Insight is committed to supporting our community with tools, data, and resources that help elevate care. Events like remind us how collaboration can make such an impact!

Thank you to the Amputee Coalition and everyone who helped make this year’s conference unforgettable. We’re looking forward to building on this momentum throughout 2026. 💙

01/15/2026

Heads up, providers:

For dates of service on or after January 1, 2026, the SC modifier must be billed with Lymphedema Compression Garments when all statutory and reasonable and necessary requirements are met.

Similar to the KX modifier, the SC modifier should be included on all claims for lymphedema garments if coverage criteria is supported.

🔗 Learn more: https://bit.ly/45WF3h8

01/14/2026

There is still time to register for our January Webinar!

Medicare KO LCD + Policy Changes are here—and understanding these updates is critical for your practice.

Join us for an important discussion on Medicare KO LCD +policy changes.

📅 Monday, January 21
🕒 11:30 AM PST

This session will cover what these updates mean for your practice and how to stay compliant while continuing to deliver exceptional patient care.

Register: https://bit.ly/4qLoVaw

01/13/2026

Big news for DMEPOS suppliers! 🚨

Under the Final Rule CMS-1828-F, Medicare will now grant Prior Authorization exemptions to suppliers with a 90% affirmed rate.

Suppliers can still choose to submit prior authorizations while exempt and will receive written notice of both qualification and any revocation.

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

01/12/2026

The 2026 American Orthotic and Prosthetic Association Leadership Meeting in Huntington Beach, CA has officially wrapped!

It was an inspiring event, sharing how insight is driving action through innovation, optimizing big data, and managing change disruptors.

Our very own Lesleigh Sisson, CFo, CFm, attended engaging sessions, connected with industry leaders, and soaked up some California sunshine. 😎 Hats off to all who made this event so impactful!

01/07/2026

Medicare has officially finalized updates to the LCD and Policy Article for Knee Orthoses—and these changes will impact coverage, documentation, and compliance moving forward.

To help practices stay ahead, our team is hosting a comprehensive, no‑cost webinar walking through what changed, what didn’t, and what it means for your workflow.

🔍 What We’ll Cover:
• Timeline of Events — How we got here (5 min)
• Finalized KO LCD & Policy Article Changes (20 min)
• Review of Existing Coverage Criteria — What remains the same (20 min)
• Resources + Q&A (15 min)

If your practice provides knee orthoses—or supports billing and documentation—this session will provide clarity and confidence heading into 2025.

Save your spot: https://bit.ly/4qLoVaw

12/31/2025

🎉 Wrapping up 2025 with Important News for Suppliers!

The 2026 DMEPOS Fee Schedule (DME26-A) is now live on the CMS website. This Excel file includes updated reimbursement rates effective January 1, 2026.

✅ Download here: https://bit.ly/3N0SiXB

12/29/2025

The CMS Final Rule CMS‑1828‑F sets a tentative timeline for reopening competitive bidding under Fee-for-Service Medicare.

Key changes include:
🔹Addition of a new product category: Off-the-Shelf (OTS) upper extremity orthoses
🔹Implementation of a Remote Item Delivery (RID) process, awarding nationwide contracts for delivery of OTS orthoses

These updates aim to modernize delivery and expand access while maintaining program integrity.

Learn more about these and other competitive bidding changes in the full rule: https://bit.ly/4oMVJ1d

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

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http://www.oandpinsight.com/

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