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e-CFR data is current as of July 31, 2020

Title 42Chapter IVSubchapter FPart 476Subpart C → §476.85


Title 42: Public Health
PART 476—QUALITY IMPROVEMENT ORGANIZATION REVIEW
Subpart C—Review Responsibilities of Quality Improvement Organizations (QIOs)


§476.85   Conclusive effect of QIO initial denial determinations and changes as a result of DRG validations.

A QIO initial denial determination or change as a result of DRG validation is final and binding unless, in accordance with the procedures in part 473—

(a) The initial denial determination is reconsidered and revised; or

(b) The change as a result of DRG validation is reviewed and revised.

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