Khush Singh, MD, MHA, CRC, CPMA, CPCO

Senior Consultant
(717) 556-1088
280 Granite Run Drive, Suite 310
Lancaster, PA 17601

Khush Singh, MD is a trained clinician and an experienced healthcare management executive with more than 15 years of health information management (HIM) and CMS Managed Care (Medicare & Medicaid) regulatory experience. Khush focuses on helping his clients through his expertise in Medicare risk adjustment and coding compliance, specifically assisting medical providers succeed in value-based care programs while staying compliant under the Medicare Part C program guidelines and other APMs (Alternate Payment Models). 

Khush has a passion for working with clinical data models that leverage healthcare data to improve patient lives and help medical providers serve their patients in a meaningful way. He started his HIM career by managing clinical study data for industry-sponsored FDA clinical trials. He also led the risk adjustment coding and compliance teams, often acting a liaison between medical providers and the managed care business world. 

While serving as a senior leader on risk adjustment teams at number of MA health plans, he oversaw Medicare, Medicaid and commercial ACA risk adjustment efforts. He has also worked as a consultant providing physician practices with HCC coding education and quality and value-based care HIM expertise. Specifically, he has helped clients refine their HCC coding recapture workflows, resolve EDPS submission-related problems, and leveraged the clinical documentation improvement process to recapture appropriate and accurate HCC risk scores for the Medicare & Medicaid lives under management. 

Khush has also served as a senior executive at a healthcare technology vendor company. While there, he engaged with risk adjustment and finance executives at several large national MA, Medicaid and commercial health plans and large physician group ACOs, to improve their risk adjustment coding and documentation workflows focused on optimizing risk revenue streams while maintaining compliance with CMS risk adjustment data validation (RADV) guidelines. 

An active thought leader, Khush speaks at national and regional coding and managed care conferences on topics related to risk adjustment HCC coding, RADV audit compliance, MA risk adjustment operations and NLP technology solutions for risk adjustment.  

University of Washington, Master of Health Services Administration, 2007

Educational Commission for Foreign Medical Graduates, M.D. in Medicine, 2012

University of Washington, Certificate Program in Medical Management, 2006

Baba Farid University of Health Sciences, M.B.B.S, 2000

AAPC

  • Certified Professional Coder (ICD-9 & ICD-10 proficient)
  • Certified Professional Medical Auditor
  • Certified Risk Adjustment Coder
  • Certified Professional Compliance Officer

AHIMA

  • Certified Documentation Improvement Practitioner

Master of Public Administration, Pennsylvania State University

Bachelor of Arts in Political Sciences, Gannon University

Fellow, American College of Healthcare Executives (2015-Present)

Fellow, Certified Professional Coder, American Academy of Professional Coders (1999-Present; Fellow Status Awarded September 2019)

Certified Professional Coder, American Academy of Professional Coders (1999-Present)

Certified in Healthcare Compliance, Healthcare Compliance Association (1999-Present)

Certified in Six Sigma, Green Belt in Lean and Lean Six Sigma, Villanova University (2010-2016)

Clinical Coding and Risk Adjustment focus areas of expertise and projects undertaken:

 

Prospective, concurrent and retrospective risk adjustment process re-design & implementation

Development of diagnosis ICD-10-CM coding and compliance audit workflows

Clinical Document Integrity (CDI) focused HCC recapture workflow re-designs for IPAs

Development of diagnosis coding compliance program structure (for IPAs and MA plans)

Design and implementation of medical provider and coder HCC coding education programs

Clinical suspect analytics and HCC recapture logic development (CMS & HHS-HCC & CDPS-Rx)

Actuarial Risk adjustment Matrix modelling

Development and deployment of “Risk Score Optimization” methodology for IPAs

EDPS and RAPS data submission process restructure and compliance oversight

RAPS/EDPS reconciliations for supplemental data submission for MA plans

Design and interfacing of NLP technology driven risk adjustment coding workflows

Risk adjustment focused claims analytical architecture development (for IPAs & MA plans)

Interfacing MA Risk adjustment with HEDIS & Quality programs

Retrospective chart reviews campaign management for MA and ACA commercial plans

RADV audit preparedness, designing and conducting HCC-focused mock audits

Risk adjustment analytics and coding vendor management and oversight