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e-CFR data is current as of July 1, 2020

Title 42Chapter IVSubchapter FPart 476


TITLE 42—Public Health

CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED)

SUBCHAPTER F—QUALITY IMPROVEMENT ORGANIZATIONS

PART 476—QUALITY IMPROVEMENT ORGANIZATION REVIEW

rule

Subpart A—GENERAL PROVISIONS

§476.1
Definitions.
rule

Subpart B—[RESERVED]

rule

Subpart C—REVIEW RESPONSIBILITIES OF QUALITY IMPROVEMENT ORGANIZATIONS (QIOS)

General Provisions

§476.70
Statutory bases and applicability.
§476.71
QIO review requirements.
§476.73
Notification of QIO designation and implementation of review.
§476.74
General requirements for the assumption of review.
§476.76
Cooperation with health care facilities.
§476.78
Responsibilities of providers and practitioners.
§476.80
Coordination with Medicare administrative contractors, fiscal intermediaries, and carriers
§476.82
Continuation of functions not assumed by QIOs.

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.

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