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FEDERAL · 42 CFR

Part 476 — Quality Improvement Organization Review

29 sections · Title 42: Public Health

§ 476.1Definitions.
§ 476.70Statutory bases and applicability.
§ 476.71QIO review requirements.
§ 476.73Notification of QIO designation and implementation of review.
§ 476.74General requirements for the assumption of review.
§ 476.76Cooperation with health care facilities.
§ 476.78Responsibilities of providers and practitioners.
§ 476.80Coordination with Medicare administrative contractors, fiscal intermediaries, and carriers
§ 476.82Continuation of functions not assumed by QIOs.
§ 476.83Initial denial determinations.
§ 476.84Changes as a result of DRG validation.
§ 476.85Conclusive effect of QIO initial denial determinations and changes as a result of DRG validations.
§ 476.86Correlation of Title XI functions with Title XVIII functions.
§ 476.88Examination of the operations and records of health care facilities and practitioners.
§ 476.90Lack of cooperation by a provider or practitioner.
§ 476.93Opportunity to discuss proposed initial denial determination and changes as a result of a DRG validation.
§ 476.94Notice of QIO initial denial determination and changes as a result of a DRG validation.
§ 476.96Review period and reopening of initial denial determinations and changes as a result of DRG validations.
§ 476.98Reviewer qualifications and participation.
§ 476.100Use of norms and criteria.
§ 476.102Involvement of health care practitioners other than physicians.
§ 476.104Coordination of activities.
§ 476.110Use of immediate advocacy to resolve oral beneficiary complaints.
§ 476.120Submission of written beneficiary complaints.
§ 476.130Beneficiary complaint review procedures.
§ 476.140Beneficiary complaint reconsideration procedures.
§ 476.150Abandoned complaints and reopening rights.
§ 476.160General quality of care review procedures.
§ 476.170General quality of care reconsideration procedures.