25% Fewer Denials, 5.7x ROI: Fox Valley Orthopedics’ AI-Powered RCM Transformation

Meet the Client

Fox Valley Orthopedics is a leading orthopedic care provider based in Illinois, serving 35,000 patients annually across a network of physical therapy clinics, ambulatory surgery centers, and specialty practices. Committed to delivering compassionate, efficient care, Fox Valley invests in cutting-edge technologies and clinical advancements to remain at the forefront of orthopedic medicine. This forward-thinking approach extends beyond clinical care as the organization embraces AI-driven tools to improve revenue cycle management (RCM). As the organization grows, its RCM team remains focused on driving operational excellence by identifying issues earlier, reducing denials, and accelerating reimbursement.

The Challenge

Limited Visibility Across the Revenue Cycle

Fox Valley faced a persistent obstacle: limited visibility into the full claim lifecycle. Errors on the front end, like eligibility or prior authorization errors, were silently impacting reimbursement downstream. Without a unified view of the revenue cycle, connecting those dots and taking corrective action was slow and reactive.

Manual and Inconsistent Reporting

Gathering actionable insights was labor-intensive. Teams had to reconcile disparate reports from multiple systems, often resulting in delays, inconsistent metrics, and a fragmented view into key metrics and performance.

Time-Consuming Trend Analysis

Spotting patterns in denials required hours of manual data analysis. This not only slowed down revenue recovery but also diverted staff from higher-value activities like process improvement and patient communication.

The Solution: From Alerts to Action

Adonis equipped Fox Valley with a smarter, faster approach to denial management by surfacing key issues early and streamlining response workflows.

Real-Time Alerts

Using Adonis Alerts, the team could proactively identify denial trends as they emerged and before they became revenue threats. These alerts gave early warning signals for issues like prior authorization denials, prompting faster investigation.

Task Prioritizations

Customizable worklists turned insights into action. Staff were able to take immediate action on high-impact tasks, resolve denial root causes efficiently, and minimize time spent searching for issues.

The Impact: Faster Response, Stronger Results

Case 1: $200K in Denials Prevented

In late 2023, Adonis flagged a sudden 104% increase in CO197 denials in Fox Valley’s Physical Therapy clinics. The issue was linked to a change in United Healthcare’s prior authorization policy for CPT code 97110. With help from Adonis, the team quickly traced the issue to mid-September claims. The team swiftly obtained retro-authorizations, submitted corrected claims, and trained staff on the new rule, avoiding over $200K in potential lost revenue.

Within three weeks, denial rates dropped from 25% to 4%, an 84% improvement.

Case 2: Denials Decrease by 60% in One Week

A few months later, Adonis caught another spike in CO197 denials, this time at Fox Valley’s Ambulatory Surgery Center. The problem was caused by billing codes that didn’t match what had been approved. The team acted quickly, correcting the issue, and within a week, denial rates dropped from 33% to 13%, a 60% improvement.

Though these alerts were tied to the same denial code, each stemmed from a distinct root cause. Adonis made these differences distinct and highly actionable, empowering teams to respond with precision.

Beyond Denials: Transforming Operations

Faster Action Through Real-Time Visibility

Fox Valley’s team now spends less time digging through data and more time fixing issues. With quick access to key insights, they can take action right away, leading to faster payments, better cash flow, and smarter use of staff time.

Stronger Cross-Team Alignment

From front-desk intake to clinical services and billing, teams now share a unified understanding of their impact on the revenue cycle. This alignment has improved collaboration and helped create a better patient experience.

Driving ROI

Since launching our partnership less than a year ago, the client has achieved a 25% reduction in denial rates from insurance payers. And in just the first four months of 2025, they’ve already realized a 5.7x return on investment from Adonis’ Alerting capabilities, empowering their team to proactively identify and resolve issues faster than ever before.

Conclusion

By partnering with Adonis, Fox Valley Orthopedics has demonstrated a clear commitment to innovation, not just in clinical care, but in the way it runs its business. The organization has embraced advanced technologies like AI to drive smarter, faster decision-making across the revenue cycle.

Their adoption of AI-powered RCM technology has transformed their revenue cycle into a strategic asset, improving financial outcomes, strengthening operational excellence, and driving a better experience for patients and staff alike.

Looking into the future, I am optimistic about innovation and staying ahead of healthcare curve balls. Adonis has removed the guesswork, monotony, and manual burden from reporting and other revenue cycle workflows. We can now focus on what truly matters, the patients - Elizabeth Bauer, Process Manager