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- Code of Federal Regulations
- C.F.R. Title 42—Public Health
- CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES
- SUBCHAPTER F—QUALITY IMPROVEMENT ORGANIZATIONS
- PART 476—QUALITY IMPROVEMENT ORGANIZATION REVIEW
- Subpart C—Review Responsibilities of Quality Improvement Organizations (QIOs)
- QIO Review Functions
42 C.F.R. § 476.104
Coordination of activities.
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Source: 50 FR 15330, Apr. 17, 1985, as amended at 77 FR 68561, Nov. 15, 2012
Table of Contents
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.