QIO Review Functions

1. CFR
2. ›
3. Title 42
4. ›
5. Chapter IV
6. ›
7. Part 476
8. ›
9. Subpart C
10. ›
11. Subject Group QIO Review Functions

Sections

Section numbering in the official eCFR can be non-consecutive. Omitted section numbers are not treated here as reserved unless the source explicitly labels them that way.

• 476.83
  § 476.83 Initial denial determinations.
• 476.84
  § 476.84 Changes as a result of DRG validation.
• 476.85
  § 476.85 Conclusive effect of QIO initial denial determinations and changes as a result of DRG validations.
• 476.86
  § 476.86 Correlation of Title XI functions with Title XVIII functions.
• 476.88
  § 476.88 Examination of the operations and records of health care facilities and practitioners.
• 476.90
  § 476.90 Lack of cooperation by a provider or practitioner.
• 476.93
  § 476.93 Opportunity to discuss proposed initial denial determination and changes as a result of a DRG validation.
• 476.94
  § 476.94 Notice of QIO initial denial determination and changes as a result of a DRG validation.
• 476.96
  § 476.96 Review period and reopening of initial denial determinations and changes as a result of DRG validations.
• 476.98
  § 476.98 Reviewer qualifications and participation.
• 476.100
  § 476.100 Use of norms and criteria.
• 476.102
  § 476.102 Involvement of health care practitioners other than physicians.
• 476.104
  § 476.104 Coordination of activities.
• 476.110
  § 476.110 Use of immediate advocacy to resolve oral beneficiary complaints.
• 476.120
  § 476.120 Submission of written beneficiary complaints.
• 476.130
  § 476.130 Beneficiary complaint review procedures.
• 476.140
  § 476.140 Beneficiary complaint reconsideration procedures.
• 476.150
  § 476.150 Abandoned complaints and reopening rights.
• 476.160
  § 476.160 General quality of care review procedures.
• 476.170
  § 476.170 General quality of care reconsideration procedures.