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Electronic Code of Federal Regulations

e-CFR data is current as of April 8, 2020

Title 42Chapter IVSubchapter FPart 478


TITLE 42—Public Health

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

SUBCHAPTER F—QUALITY IMPROVEMENT ORGANIZATIONS

PART 478—RECONSIDERATIONS AND APPEALS

rule

Subpart A—[RESERVED]

rule

Subpart B—UTILIZATION AND QUALITY CONTROL QUALITY IMPROVEMENT ORGANIZATION (QIO) RECONSIDERATIONS AND APPEALS

§478.10
Scope.
§478.12
Statutory basis.
§478.14
Applicability.
§478.15
QIO review of changes resulting from DRG validation.
§478.16
Right to reconsideration.
§478.18
Location for submitting requests for reconsideration.
§478.20
Time limits for requesting reconsideration.
§478.22
Good cause for late filing of a request for a reconsideration or hearing.
§478.24
Opportunity for a party to obtain and submit information.
§478.26
Delegation of the reconsideration function.
§478.28
Qualifications of a reconsideration reviewer.
§478.30
Evidence to be considered by the reconsideration reviewer.
§478.32
Time limits for issuance of the reconsidered determination.
§478.34
Notice of a reconsidered determination.
§478.36
Record of reconsideration.
§478.38
Effect of a reconsidered determination.
§478.40
Beneficiary's right to a hearing.
§478.42
Submitting a request for a hearing.
§478.44
Determining the amount in controversy for a hearing.
§478.46
Medicare Appeals Council and judicial review.
§478.48
Reopening and revision of a reconsidered determination or a decision.

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