Regulatory Headwinds: Medicare Advantage and Value-Based Care Mantra for Success1 CEUDescriptionCDI professionals must be aware of the regulatory and documentation requirements at play to perform their roles effectively. This session will provide an overview of the latest updates to the Medicare risk adjustment program, including findings from the Office of Inspector General and Health and Human Services audits, CMS recommendations and action plans to address coding compliance issues. Attendees will then learn how these audits and recommendations have implications for the False Claims Act and will impact the future of the Medicare risk adjustment program, hierarchical condition category coding, and value-based care. Learning Objectives:
Featured SpeakerKhush Singh, MD, MHA, CPC<CRC, CPCO, CPMA, CDIP Dr. Khush Singh is a trained clinician and experienced healthcare executive with nearly two decades of combined HIM and Medicare experience. In his recent career sprint, Khush has served in several senior leadership roles within Risk Adjustment (RA) teams at Medicare Advantage health plans, MSOs, ACOs and overseeing Medicare, Medicaid, and commercial risk adjustment and Quality departments. Khush leads focused engagements, providing expertise in risk adjustment operations, healthcare data analytics, HCC coding, and operational compliance components of Medicare’s Part C and Part D. He has led a variety of projects, including RA process improvement, prep for RADV audits, retrospective and concurrent chart retrieval, coding, and auditing campaigns, provider and coder education, and structuring and optimizing RA programs within MSOs and IPAs. Khush has worked with entities ranging from EMR vendors, risk adjustment solution vendors for NLP and advanced HCC analytics, billing and coding, revenue cycle management entities, MAOs, and ACOs. He regularly engages with physician practices focused on managed care, providing HCC coding and documentation education to providers. He has helped several clients optimize their HCC coding recapture and CDI workflows, resolve EMR workflow & claims issues, RAPS and EDPS submission-related problems, and help them with their clinical documentation improvement & CDI process to recapture appropriate & accurate HCC risk scores, HEDIS recapture and help improving STARS ratings. As an experienced SME in the space, Khush helps program directors and leadership in navigating and optimizing their risk adjustment programs in meeting their regulatory and compliance objectives, enabling monitoring of fraud, waste & abuse within their organisations. Khush Singh regularly speaks at national and regional conferences for AAPC, RISE, ACDIS, and other conferences on topics related to Risk Adjustment, HCC coding, RADV audit compliance, MAO operations, and technology solutions for managed care focused on patient-centric RA and quality of care |