In a newly published survey of Illinois physicians, 72% report their practice has experienced automatic downcoding of appropriately documented claims.
CHICAGO, IL, UNITED STATES, June 17, 2026 /EINPresswire.com/ — A new report from the Illinois State Medical Society (ISMS) shows the practice of downcoding is affecting the majority of physicians and healthcare professionals in the state.
The survey includes responses from more than 330 physicians and healthcare professionals and was conducted from January 25 to February 25, 2026.
Downcoding is the automatic assignment of a lower-level billing code by a health insurer that overrides and reduces the level of service that physicians are submitting on their medical claims. This is frequently based on algorithms or standardized payment policies — resulting in a lower reimbursement that does not reflect the actual time and complexity of treatment provided to a patient.
The report finds that:
• Nearly three-quarters of survey respondents (72%) indicated that their practice has experienced automatic downcoding of appropriately documented claims. This means that a large majority of Illinois’ physicians have been underpaid by insurers for the services they actually provided to patients.
• Seventy-seven percent of physicians reported that they’ve seen automatic downcoding increase in the past 5 years.
• Almost three-quarters (72%) of survey respondents indicated that even when the remittance advice indicates a downcoded claim, it rarely or never includes a specific reason why. This means that even in cases where practices can identify a claim has been downcoded, often they have no idea why the decision was made and, more importantly, what information the payer needs to modify their decision.
“As physicians, we’re drawn to this profession to help people and to care for patients when they’re feeling their worst. When health insurers put up barriers to that care, it not only makes it harder to do our jobs, it endangers the sustainability of our practices,” ISMS President Dr. Tripti Kataria said.
Click here to read the full report.
Aaron Franco
Illinois State Medical Society
+1 (312) 580-6450
email us here
Legal Disclaimer:
EIN Presswire provides this news content “as is” without warranty of any kind. We do not accept any responsibility or liability
for the accuracy, content, images, videos, licenses, completeness, legality, or reliability of the information contained in this
article. If you have any complaints or copyright issues related to this article, kindly contact the author above.
Media gallery
