42 CFR Part 478 — Reconsiderations and Appeals

Subpart B — Utilization and Quality Control Quality Improvement Organization (QIO) Reconsiderations and Appeals

• § 478.10— Scope.
• § 478.12— Statutory basis.
• § 478.14— Applicability.
• § 478.15— QIO review of changes resulting from DRG validation.
• § 478.16— Right to reconsideration.
• § 478.18— Location for submitting requests for reconsideration.
• § 478.20— Time limits for requesting reconsideration.
• § 478.22— Good cause for late filing of a request for a reconsideration or hearing.
• § 478.24— Opportunity for a party to obtain and submit information.
• § 478.26— Delegation of the reconsideration function.
• § 478.28— Qualifications of a reconsideration reviewer.
• § 478.30— Evidence to be considered by the reconsideration reviewer.
• § 478.32— Time limits for issuance of the reconsidered determination.
• § 478.34— Notice of a reconsidered determination.
• § 478.36— Record of reconsideration.
• § 478.38— Effect of a reconsidered determination.
• § 478.40— Beneficiary's right to a hearing.
• § 478.42— Submitting a request for a hearing.
• § 478.44— Determining the amount in controversy for a hearing.
• § 478.46— Medicare Appeals Council and judicial review.
• § 478.48— Reopening and revision of a reconsidered determination or a decision.