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Section 476.1
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Statutory bases and applicability |
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Section 476.70
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QIO review requirements |
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Section 476.71
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Notification of QIO designation and implementation of review |
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Section 476.73
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General requirements for the assumption of review |
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Section 476.74
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Cooperation with health care facilities |
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Section 476.76
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Responsibilities of providers and practitioners |
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Section 476.78
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Coordination with Medicare administrative contractors, fiscal intermediaries, and carriers |
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Section 476.80
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Continuation of functions not assumed by QIOs |
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Section 476.82
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Initial denial determinations |
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Section 476.83
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Changes as a result of DRG validation |
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Section 476.84
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Conclusive effect of QIO initial denial determinations and changes as a result of DRG validations |
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Section 476.85
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Correlation of Title XI functions with Title XVIII functions |
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Section 476.86
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Examination of the operations and records of health care facilities and practitioners |
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Section 476.88
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Lack of cooperation by a provider or practitioner |
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Section 476.90
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Opportunity to discuss proposed initial denial determination and changes as a result of a DRG validation |
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Section 476.93
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Notice of QIO initial denial determination and changes as a result of a DRG validation |
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Section 476.94
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Review period and reopening of initial denial determinations and changes as a result of DRG validations |
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Section 476.96
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Reviewer qualifications and participation |
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Section 476.98
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Use of norms and criteria |
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Section 476.100
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Involvement of health care practitioners other than physicians |
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Section 476.102
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Coordination of activities |
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Section 476.104
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Use of immediate advocacy to resolve oral beneficiary complaints |
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Section 476.110
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Submission of written beneficiary complaints |
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Section 476.120
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Beneficiary complaint review procedures |
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Section 476.130
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Beneficiary complaint reconsideration procedures |
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Section 476.140
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Abandoned complaints and reopening rights |
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Section 476.150
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General quality of care review procedures |
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Section 476.160
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General quality of care reconsideration procedures |
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Section 476.170
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Scope |