42 CFR Subpart B
Utilization and Quality Control Quality Improvement Organization (QIO) Reconsiderations and Appeals
June 11, 2020
§
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
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