How an IONM Company Recovered $1.9M from Systematic Denials
Fighting medical necessity denials with clinical evidence
IONM Services Provider
IONM Services Provider
About
A specialized intraoperative neuromonitoring company providing real-time nervous system monitoring during high-risk surgeries across 45 hospitals.
Industry
Intraoperative Neuromonitoring
Company size
80-100 employees
Headquarters
Phoenix, AZ
Founded
2015
Annual Claims
$18M+ billed annually
Key Features Used
Challenge
IONM services face unique payment challenges. Payers frequently deny claims citing "lack of medical necessity" or bundle IONM into surgical facility fees. The provider was experiencing a 34% denial rate and recovering only 41% of billed charges on paid claims.
Solution
Deploy Clearest to build evidence-based dispute packets combining peer benchmark data with clinical outcome studies demonstrating the medical necessity and value of IONM services during complex spine and cranial surgeries.
Illustrative Results
$1.9M recovered
Revenue recovered from overturned denials
87% overturn rate
On medical necessity denials
34% to 12%
Denial rate reduction
67% increase
In average reimbursement per case
The IONM payment problem
Intraoperative neuromonitoring is a specialized service that protects patients during high-risk surgeries. Technologists monitor the nervous system in real-time, alerting surgeons to potential damage before it becomes permanent. The service has been shown to reduce neurological complications by up to 50%.
Despite clear clinical value, payers have increasingly targeted IONM for denials. Common tactics include claiming the service was not medically necessary, bundling IONM into facility fees, or simply underpaying without explanation.
The provider had built strong clinical relationships with surgeons who relied on their services, but their revenue cycle was in crisis. One-third of claims were being denied, and even approved claims were paid at rates far below what the service cost to provide.
Illustrative perspective
Surgeons were requesting our services because they knew IONM protected their patients. But payers were treating us like we were optional.
Building the clinical case
IONM disputes require a different approach than typical underpayment cases. The primary battle is proving medical necessity. Clearest built comprehensive evidence packages that included peer-reviewed studies, surgical society guidelines, and outcome data.
Each dispute packet documented the specific procedure, the risks being monitored, and the clinical rationale for IONM. For cases where real-time alerts occurred, the documentation showed exactly how monitoring protected the patient.
The platform also tracked emerging case law and regulatory guidance on IONM coverage, ensuring disputes cited the most current standards.
Overturning denials at scale
The clinical evidence approach proved highly effective. Arbitrators consistently sided with the provider when presented with surgical society guidelines recommending IONM for the specific procedure type.
More importantly, the systematic documentation of denials revealed patterns. Certain payers were denying virtually all IONM claims regardless of clinical circumstances. This data supported complaints to state insurance commissioners.
Illustrative perspective
When we could show that a payer denied IONM for a procedure where every major surgical society recommends monitoring, the denial became indefensible.
A sustainable model for specialized services
The 67% increase in average reimbursement transformed the provider's financial position. They expanded coverage to 12 additional hospitals and invested in advanced monitoring equipment.
The reduction in denial rate from 34% to 12% also freed up significant staff time previously spent on appeals. That team now focuses on proactive authorization and documentation to prevent denials before they occur.
Illustrative perspective
Clearest gave us the tools to fight back. IONM saves lives, and now we can prove it saves money too.
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