Title 42

PART 478 SUBPART B

Subpart B - Utilization and Quality Control Quality Improvement Organization (QIO) Reconsiderations and Appeals Source:50 FR 15372, Apr. 17, 1985, unless otherwise noted. Redesignated at 64 FR 66279, Nov. 24, 1999.

Secs. 1102 and 1871 of the Social Security Act (42 U.S.C. 1302 and 1395hh).
Source:

42:4.0.1.4.19.2.186.1	SECTION 478.10	478.10 Scope.
42:4.0.1.4.19.2.186.2	SECTION 478.12	478.12 Statutory basis.
42:4.0.1.4.19.2.186.3	SECTION 478.14	478.14 Applicability.
42:4.0.1.4.19.2.186.4	SECTION 478.15	478.15 QIO review of changes resulting from DRG validation.
42:4.0.1.4.19.2.186.5	SECTION 478.16	478.16 Right to reconsideration.
42:4.0.1.4.19.2.186.6	SECTION 478.18	478.18 Location for submitting requests for reconsideration.
42:4.0.1.4.19.2.186.7	SECTION 478.20	478.20 Time limits for requesting reconsideration.
42:4.0.1.4.19.2.186.8	SECTION 478.22	478.22 Good cause for late filing of a request for a reconsideration or hearing.
42:4.0.1.4.19.2.186.9	SECTION 478.24	478.24 Opportunity for a party to obtain and submit information.
42:4.0.1.4.19.2.186.10	SECTION 478.26	478.26 Delegation of the reconsideration function.
42:4.0.1.4.19.2.186.11	SECTION 478.28	478.28 Qualifications of a reconsideration reviewer.
42:4.0.1.4.19.2.186.12	SECTION 478.30	478.30 Evidence to be considered by the reconsideration reviewer.
42:4.0.1.4.19.2.186.13	SECTION 478.32	478.32 Time limits for issuance of the reconsidered determination.
42:4.0.1.4.19.2.186.14	SECTION 478.34	478.34 Notice of a reconsidered determination.
42:4.0.1.4.19.2.186.15	SECTION 478.36	478.36 Record of reconsideration.
42:4.0.1.4.19.2.186.16	SECTION 478.38	478.38 Effect of a reconsidered determination.
42:4.0.1.4.19.2.186.17	SECTION 478.40	478.40 Beneficiary's right to a hearing.
42:4.0.1.4.19.2.186.18	SECTION 478.42	478.42 Submitting a request for a hearing.
42:4.0.1.4.19.2.186.19	SECTION 478.44	478.44 Determining the amount in controversy for a hearing.
42:4.0.1.4.19.2.186.20	SECTION 478.46	478.46 Medicare Appeals Council and judicial review.
42:4.0.1.4.19.2.186.21	SECTION 478.48	478.48 Reopening and revision of a reconsidered determination or a decision.