QIO Review Functions
- §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.