42 CFR § 476.85
Conclusive effect of QIO initial denial determinations and changes as a result of DRG validations
June 11, 2020
A QIO initial denial determination or change as a result of DRG validation is final and binding unless, in accordance with the procedures in part 473—
(a) The initial denial determination is reconsidered and revised; or
(b) The change as a result of DRG validation is reviewed and revised.
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