Title 42

PART 476

Part 476 - Quality Improvement Organization Review

PART 476 - QUALITY IMPROVEMENT ORGANIZATION REVIEW Authority:Secs. 1102 and 1871 of the Social Security Act (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.

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