42 CFR Part 476 — Quality Improvement Organization Review
Subpart A — General Provisions
Subpart C — Review Responsibilities of Quality Improvement Organizations (QIOs)
- § 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.
- § 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.