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
- Certified Professional Coder (ICD-9 & ICD-10 proficient)
- Certified Professional Medical Auditor
- Certified Risk Adjustment Coder
- Certified Professional Compliance Officer
- Certified Documentation Improvement Practitioner
American Medical Association (AMA)
Washington Association of Physicians of Indian Origin (WAPI)
Indian American Medical Association, Illinois (IAMA-IL)
American Academy of Professional Coders (AAPC)
American Health Information Management Association (AHIMA)
Association of Clinical Documentation Improvement Specialists (ACDIS)
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