Title 42

PART 476

Part 476 - Quality Improvement Organization Review

PART 476 - QUALITY IMPROVEMENT ORGANIZATION REVIEW Authority:42 U.S.C. 1302 and 1395hh. Source:44 FR 32081, June 4, 1979, unless otherwise noted. Redesignated at 64 FR 66279, Nov. 24, 1999.

• Authority: 42 U.S.C. 1302 and 1395hh.
• Source: 44 FR 32081, June 4, 1979, unless otherwise noted. Redesignated at 64 FR 66279, Nov. 24, 1999.

42:4.0.1.4.18.1	SUBPART A	Subpart A - General Provisions
42:4.0.1.4.18.1.184.1	SECTION 476.1	476.1 Definitions.
42:4.0.1.4.18.2	SUBPART B	Subpart B [Reserved]
42:4.0.1.4.18.3	SUBPART C	Subpart C - Review Responsibilities of Quality Improvement Organizations (QIOs)
42:4.0.1.4.18.3.184	SUBJGRP 184	General Provisions
42:4.0.1.4.18.3.184.1	SECTION 476.70	476.70 Statutory bases and applicability.
42:4.0.1.4.18.3.184.2	SECTION 476.71	476.71 QIO review requirements.
42:4.0.1.4.18.3.184.3	SECTION 476.73	476.73 Notification of QIO designation and implementation of review.
42:4.0.1.4.18.3.184.4	SECTION 476.74	476.74 General requirements for the assumption of review.
42:4.0.1.4.18.3.184.5	SECTION 476.76	476.76 Cooperation with health care facilities.
42:4.0.1.4.18.3.184.6	SECTION 476.78	476.78 Responsibilities of providers and practitioners.
42:4.0.1.4.18.3.184.7	SECTION 476.80	476.80 Coordination with Medicare administrative contractors, fiscal intermediaries, and carriers
42:4.0.1.4.18.3.184.8	SECTION 476.82	476.82 Continuation of functions not assumed by QIOs.
42:4.0.1.4.18.3.185	SUBJGRP 185	QIO Review Functions
42:4.0.1.4.18.3.185.9	SECTION 476.83	476.83 Initial denial determinations.
42:4.0.1.4.18.3.185.10	SECTION 476.84	476.84 Changes as a result of DRG validation.
42:4.0.1.4.18.3.185.11	SECTION 476.85	476.85 Conclusive effect of QIO initial denial determinations and changes as a result of DRG validations.
42:4.0.1.4.18.3.185.12	SECTION 476.86	476.86 Correlation of Title XI functions with Title XVIII functions.
42:4.0.1.4.18.3.185.13	SECTION 476.88	476.88 Examination of the operations and records of health care facilities and practitioners.
42:4.0.1.4.18.3.185.14	SECTION 476.90	476.90 Lack of cooperation by a provider or practitioner.
42:4.0.1.4.18.3.185.15	SECTION 476.93	476.93 Opportunity to discuss proposed initial denial determination and changes as a result of a DRG validation.
42:4.0.1.4.18.3.185.16	SECTION 476.94	476.94 Notice of QIO initial denial determination and changes as a result of a DRG validation.
42:4.0.1.4.18.3.185.17	SECTION 476.96	476.96 Review period and reopening of initial denial determinations and changes as a result of DRG validations.
42:4.0.1.4.18.3.185.18	SECTION 476.98	476.98 Reviewer qualifications and participation.
42:4.0.1.4.18.3.185.19	SECTION 476.100	476.100 Use of norms and criteria.
42:4.0.1.4.18.3.185.20	SECTION 476.102	476.102 Involvement of health care practitioners other than physicians.
42:4.0.1.4.18.3.185.21	SECTION 476.104	476.104 Coordination of activities.
42:4.0.1.4.18.3.185.22	SECTION 476.110	476.110 Use of immediate advocacy to resolve oral beneficiary complaints.
42:4.0.1.4.18.3.185.23	SECTION 476.120	476.120 Submission of written beneficiary complaints.
42:4.0.1.4.18.3.185.24	SECTION 476.130	476.130 Beneficiary complaint review procedures.
42:4.0.1.4.18.3.185.25	SECTION 476.140	476.140 Beneficiary complaint reconsideration procedures.
42:4.0.1.4.18.3.185.26	SECTION 476.150	476.150 Abandoned complaints and reopening rights.
42:4.0.1.4.18.3.185.27	SECTION 476.160	476.160 General quality of care review procedures.
42:4.0.1.4.18.3.185.28	SECTION 476.170	476.170 General quality of care reconsideration procedures.

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