42 CFR Part 476
PART 476—QUALITY IMPROVEMENT ORGANIZATION REVIEW
- PART 476—QUALITY IMPROVEMENT ORGANIZATION REVIEW
- Chapter IV—Centers for Medicare & Medicaid Services, Department of Health and Human Services › Subchapter F—Quality Improvement Organizations
- Subpart A—General Provisions
- § 476.1 Definitions.
- Subpart B [Reserved]
- Subpart C—Review Responsibilities of Quality Improvement Organizations (QIOs)
- General Provisions
- § 476.70 Statutory bases and applicability.
- § 476.71 QIO review requirements.
- § 476.73 Notification of QIO designation and implementation of review.
- § 476.74 General requirements for the assumption of review.
- § 476.76 Cooperation with health care facilities.
- § 476.78 Responsibilities of providers and practitioners.
- § 476.80 Coordination with Medicare administrative contractors, fiscal intermediaries, and carriers
- § 476.82 Continuation of functions not assumed by QIOs.
- QIO Review Functions
- § 476.83 Initial denial determinations.
- § 476.84 Changes as a result of DRG validation.
- § 476.85 Conclusive effect of QIO initial denial determinations and changes as a result of DRG validations.
- § 476.86 Correlation of Title XI functions with Title XVIII functions.
- § 476.88 Examination of the operations and records of health care facilities and practitioners.
- § 476.90 Lack of cooperation by a provider or practitioner.
- § 476.93 Opportunity to discuss proposed initial denial determination and changes as a result of a DRG validation.
- § 476.94 Notice of QIO initial denial determination and changes as a result of a DRG validation.
- § 476.96 Review period and reopening of initial denial determinations and changes as a result of DRG validations.
- § 476.98 Reviewer qualifications and participation.
- § 476.100 Use of norms and criteria.
- § 476.102 Involvement of health care practitioners other than physicians.
- § 476.104 Coordination of activities.
- § 476.110 Use of immediate advocacy to resolve oral beneficiary complaints.
- § 476.120 Submission of written beneficiary complaints.
- § 476.130 Beneficiary complaint review procedures.
- § 476.140 Beneficiary complaint reconsideration procedures.
- § 476.150 Abandoned complaints and reopening rights.
- § 476.160 General quality of care review procedures.
- § 476.170 General quality of care reconsideration procedures.
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