- October 7, 2025
- Posted by: Josh Knoll
- Category: Orthotics Billing
If you are a specialists and providers of orthotics struggling to ensure proper billing, worry no more. It is quite inevitable, especially with the changes regulations, codes and insurance requirements. Managing financial health and compliance in fact is a nightmare for many Orthopedics today. Moreover, the regulatory updates and changes are rolling in for 2026, such as new CPT codes, DMEPOS reimbursement changes and tightening documentation expectations; so things are only going to get harder. Thus, it’s time to review your billing procedures. Each misstep might result which in leaving thousands, if not millions, on the table.
The common orthotics billing challenges of 2025:
Orthotics billing is already a complicated area by the amount of devices, custom fit and patient-specific adjustments. Add in increasing payer and CMS scrutiny, you only have here a very potent adversary. So, if your practice isn’t streamlined, that means denied claims, delayed reimbursement and lost revenue. Reasons why Inefficient Orthotics Billing Costs You Revenue Have you ever experienced your in-house biller personnel unknowingly leaving money on the table?, If yes, the reasons can be many. And thus, you need to understand the orthotics billing problem area first, starting from:
1. Underestimating Medical Decision-Making – Medical decision-making controls billed levels of service, especially orthotic care. And it is seen that providers generally, in order to minimize the complexity of custom fittings, patient assessment or changes to devices. The outcome can be reduced E/M coding and lost reimbursement opportunities.
2. Poor or Inaccurate form of Documentation – Medical billing documentation should include all the details of patient evaluation, orthotic prescription and follow-up care. Skipping any details such as patient functional impairments, reasons for device choice or even changes over time can result in denials. Here the only truth is effective documentation is the only way to ensure your claims are legitimate and reimbursed at appropriate levels.
3. High Claim Denial Rates – Denials mistake are many and its typically reason can be any like coding mistakes, lack of documentation or claims processing errors. While each denied claim only delays revenue here it is also true that it also incurs administrative complexity. Practices with denial rates exceeding 10% can encounter significant financial loss.
4. Inefficient Use of Technology – It is no secret that manual billing processes or suboptimal utilization of EHR and coding functionality have been the reason for inefficiency and errors many times. Advanced billing technology here have automated many documentation, verify the codes and reduce errors so that your staff can focus on patient care rather than chasing down claims.
5. Restricted Accounts Receivable (A/R) Collections – Longer A/R days negatively impact cash flow. Industry practice measures keeping A/R at or below 45 days. Without accurate billing and follow-up, payments are delayed, and operational budgets and usage are affected.
Related Reading: Best Strategies in the Optimization of Orthotics Billing
Pivotal Orthotics Billing Changes for 2026 that you need to know:
We have seen that CMS has already stated that 2026 sees significant revisions. So orthotactics professionals must understand:
- Remote Monitoring and Digital Health New CPT Codes The AMA has introduced new CPT codes for remote patient monitoring and digital health services. The codes allow providers to get paid for ongoing monitoring of orthotic patients with chronic mobility illness or chronic illnesses that must be managed over a prolonged period. Incorporating these codes can increase revenue for services previously uncompensated.
- Medicare Reimbursement Adjustments CMS has suggested revisions in Home Health Prospective Payment System (HH PPS) and DMEPOS rates for 2026. Orthotics suppliers need to be aware of these changes to avoid underbilling and make claims based on the current payment schedules.
- Tighter Compliance and Accreditation Policies It is no secret that CMS is reinforcing accreditation standards for DMEPOS providers. Thus, existing compliance requires a higher quality of documentation, quality checks, and, undoubtedly constant patient follow-up. And so any failure to meet these standards will only results in delayed or denied payment.
Top 5 Strategies to get your Optimize Orthotics Billing in 2026 sorted:
With these new regulations, providers like you might feel overwhelmed and so with our years of experience, SunKnowledge is here to provide you with top tips to get maximum revenue and remain compliant, so you experience a better ROI:
1. Enhance Your Net Collection Ratio – Watching over and improving your net collection ratio ensures all rightful reimbursement is received. Habits have a tendency to misread contractual adjustments. So, aim for a net collection ratio greater than 95%, which can directly lead to boosting your bottom line.
2. Speed Up Payment Collections – Reducing A/R days is critical. Rapid collection improves cash flow and reduces financial stress on your practice. Also, constant follow-up, dedicated billing personnel and regular monitoring of outstanding claims are any day good practices to accelerate collections.
3. Reduce Insurance Claim Denials – Denials represent a meaningful loss of revenue for any practice and your is no different. Thus, use all the detailed documentation, accurate coding and pre-submission scrutiny in order to minimize rejections. It is best that you always aim for a denial rate of less than 10% and examine claims on a routine basis to identify patterns, as it only results in fewer denials.
4. Increase First-Pass Claim Acceptance – As you know the first-pass acceptance rate is a measurement of the number of claims that are accepted without rejection or error. A standard in industry is a level of rejection of below 5%, so below it is always a good AR practice.
5. Consider Outsourcing Orthotics Billing – outsourcing to specialized billing vendors like us can revolutionize your revenue cycle. With our years of trained staff dealing with complex coding and are also current on compliance updates make your task way easy. In short, this frees your internal staff to give patient care priority while bringing every dollar your practice is owed in.
Related Reading: Orthotics Billing Made Simple: Reduce Denials and Improve Reimbursements
SunKnowledge Can Revolutionize your Orthotics Billing services
For years we have been offering end-to-end orthotics billing services that cover all angles of the revenue cycle. So if you are looking for a seamless billing operation to solve your billing AR of 2025 and ensure a better 2026 orthotics billing cycle, our expert can help. In short, with a collaboration with orthotics billing company like us you can automate processes, reduce administrative burden and ensure financial stability of the practice within a month.