Orthos

What Orthos does

Orthos, Inc. is a U.S.-based, orthopedic-specialized revenue cycle management company headquartered in South Bend, Indiana, founded circa 2020. The company delivers outsourced medical coding, billing, prior authorization, AR management, denial and collections work, and analytics to independent orthopedic practices, ambulatory surgery centers, and hospital orthopedic departments, alongside higher-value practice-transition and M&A advisory services.

Its core technology is the proprietary "Orbits" workflow management and analytics platform, supported by a purpose-built, EMR/PM-agnostic data environment and an in-house AI development team that deploys internal tooling to accelerate staff workflows. Services are delivered entirely by U.S.-based certified orthopedic coders and billing specialists with 20+ years of domain expertise across sports medicine, joint replacement, spine, and pain management.

Orthos monetizes through performance-based, outcome-aligned managed services contracts (full-service and partial/modular RCM support) and a rebadging offering that absorbs client billing teams into Orthos. The company is sales-led, distributing via website contact, phone outreach (574-406-8155), the Insights blog, LinkedIn, Facebook, and industry events such as AAOE. As of available reporting, Orthos manages over $175 million in annual client collections, primarily across mid-market orthopedic providers.

Name

Orthos

Legal name

Orthos, Inc.

Website

https://orthosinc.com

Company type

Private

Founded year

2020

Operating status

Operating

Headcount range

11–50 employees

Short description

Orthos, Inc. is a U.S.-based orthopedic-specialized revenue cycle management company that delivers outsourced coding, billing, prior authorizations, AR management, analytics, and practice-transition advisory to independent orthopedic practices, surgery centers, and hospital orthopedic departments, powered by its proprietary Orbits platform.

Ownership category

akta.pro rank

Product category

Healthcare Revenue Cycle Management

NAICS

Custom Computer Programming Services (541511), Computer Systems Design and Related Services (54151)

SIC

Services-Computer Programming, Data Processing, Etc. (7370), Services-Prepackaged Software (7372)

akta.pro primary industry

Claims Management, Scrubbing & Clearinghouse (HLACACAB)

akta.pro secondary industry

Payer-Provider Data Exchange (X12, prior auth, claims/clinical attachment) (HLACABAK)

Keywords

• Orthopedic medical billing
• Revenue cycle management
• Medical coding services
• Prior authorization management
• Denial management analytics

Headquarters

HQ city

South Bend

HQ country

United States

HQ region

North America

Offices1 record

Markets served

GTM type

B2B

Offering type

Services

Cost components

Personnel, Technology or R&D, Operations, Marketing or Sales

Revenue model

1. Revenue Cycle Management Services: Full-service RCM outsourcing for orthopedic practices including billing, coding, prior authorizations, analytics, and advisory services. Revenue is generated through performance-based contracts focused on outcomes and cost-efficiency.
2. Partial/Modular RCM Support: Partial outsourcing options allowing practices to supplement existing teams or receive surge support. Covers denials, AR management, payment posting, collections, and escalations.
3. Rebadging Services: Integration of client billing, coding, and authorization teams into Orthos, transitioning employees while maintaining continuity with existing employer (now client).

Go-to-market motion1 record

Distribution channels2 records

Marketing channels5 records

Core offering

Orthos provides outsourced, orthopedic-specialized revenue cycle management combining certified-coder-driven medical coding, billing, prior authorization, AR and denial management, and analytics for independent practices, ambulatory surgery centers, and hospital orthopedic departments. Services are delivered through its proprietary Orbits workflow management and reporting platform, with an in-house AI development team and 100% U.S.-based orthopedic billing specialists. Orthos offers full-service RCM, modular/partial outsourcing, rebadging of client billing teams, and merger and advisory support under performance-based commercial contracts.

Product overview

Orthos offers a unified revenue cycle management platform centered on its proprietary Orbits software system, complemented by a suite of specialized orthopedic billing and coding services. The core offering combines the Orbits workflow management and analytics platform with certified orthopedic medical coding, prior authorization management, billing and AR management, and strategic merger/advisory services. The Orbits platform serves as the central technology layer providing real-time reporting, claims prioritization, and data-driven insights, while the human-powered services deliver coding expertise, denial management, and practice transformation support. All services are orthopedic-specific, designed for independent practices, surgery centers, and hospitals.

Differentiator

Problem solved

Functional benefit

Products and services

• Orbits Workflow Management & Analytics Platform Proprietary software platform that prioritizes claims, identifies the most important ones to work first, ensures nothing falls through the cracks, and provides real-time reporting and analytics through a secure client portal for orthopedic practices.
• Orthopedic Medical Coding Services Certified orthopedic coder-delivered ICD-10 and CPT coding for surgical and office encounters, ensuring accurate and compliant medical code assignment for orthopedic practices, surgery centers, and hospitals.
• Prior Authorization Management Service handling prior authorizations for orthopedic procedures to minimize delays and administrative burden for practices, surgery centers, and hospitals.
• Orthopedic Billing & AR Management Full-service billing support including denial management, accounts receivable, patient questions, appeals, payment posting, collections, and escalations for orthopedic practices.
• Data and Analytics Services Analytics service combining the Orbits platform with orthopedic-specialist analysts to provide secure, insightful analytics, denial pattern deep dives, and revenue driver insights for client practices.
• Rebadging Services Service that integrates a client's in-house billing, coding, and authorization teams into Orthos while preserving employee continuity and professional development, supporting transitions such as mergers and acquisitions.
• Merger and Advisory Services Strategic advisory service for orthopedic practice transitions covering TIN conversions, policy alignment, cash flow optimization, leadership transitions, EMR changes, mergers, and divestitures.

Quantifiable outcome

• 40%+ reduction in denial rates over 3 years
• +5 more outcomes

Named customers6 records

Segments3 records

Ideal customer profiles3 records

Technology focussed Yes

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Feature3 records

Partnerships

One partnership is on record.

• ROC OrthopedicscoreStrategic or Co-development PartnerMulti-year partnership providing end-to-end RCM services for ROC Orthopedics, a multispecialty private practice in Oregon. Services include coding, billing, authorizations, and flexible support for evolving needs. Kate Othus, CEO of ROC, helped architect the partnership initially focusing on business continuity through a merger and expanding into strategic areas. ROC avoided hiring 2 additional full-time roles by drawing from Orthos resources across the country.

Scale indicators10 records

Recent moves6 records

Expansion highlights5 records

Direct peers

• AGS Health: AGS Health is a specialty-focused RCM services provider serving hospitals, health systems, and physician practices including surgical and specialty groups. Closely comparable to Orthos in combining certified specialty coders with proprietary analytics technology and a performance-driven delivery model.
• Healthrise: Healthrise provides outsourced RCM, coding, and revenue integrity services to mid-market and large healthcare providers, with a strong focus on technology-enabled workflow and analytics. Directly comparable to Orthos in targeting outsourced, outcomes-based RCM with proprietary tooling.
• Infinx: Infinx delivers AI-powered RCM services including prior authorization, coding, and patient access for specialty physician groups, hospitals, and labs. Highly comparable to Orthos's combination of AI-augmented workflows, prior auth management, and specialty-billing focus.

Broad incumbents

• R1 RCM: R1 RCM is one of the largest U.S. providers of technology-enabled RCM services to hospitals, health systems, and physician groups. A scaled, multi-specialty incumbent that competes for the same outsourced RCM budget as Orthos but with substantially broader scope and resources.
• Optum (UnitedHealth Group): Optum's RCM and healthcare services arm offers end-to-end revenue cycle, analytics, and payer-provider integration for providers of all sizes. Represents the largest competitive threat in outsourced RCM with unmatched capital, data assets, and cross-vertical bundling.
• Conifer Health Solutions: Conifer Health Solutions (a Tenet Healthcare company) provides RCM, patient access, and value-based care services to hospitals, health systems, and physician practices. A large incumbent competitor in outsourced RCM delivery with a similar hospital- and practice-anchored go-to-market.
• Waystar: Waystar provides a cloud-based RCM and payments platform covering claims management, prior authorization, denials, and patient billing. Comparable to Orthos's Orbits platform in addressing claims workflow and analytics, though Waystar is a horizontal, multi-specialty software vendor.
• Experian Health: Experian Health offers RCM, identity management, and patient access solutions for hospitals, physician practices, and labs. A broader, multi-specialty incumbent that competes with Orthos in claims management, eligibility, and analytics tooling.
• Tebra (Kareo): Tebra (formed from the merger of Kareo and PatientPop) provides practice management, EHR, and RCM software to small and mid-sized practices. Targets similar independent-practice customers with bundled software-plus-services RCM, though at a smaller scale and broader specialty mix than Orthos.

Others

• Availity: Availity operates a payer-provider data exchange and prior-authorization platform connecting providers with health plans. Not a direct RCM competitor but an adjacent enabling technology that Orthos interacts with for prior auths and eligibility workflows.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat4 records

Key risks6 records

Key highlights7 records

Customer concentration

• Facebookfacebook.com/OrthosInc
• LinkedInlinkedin.com/company/orthosinc

Revenue estimate

Valuation estimate

Number of profiles

Profiles9 records

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about Orthos