42 CFR Topic
QIO Review Functions
June 11, 2020
§
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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