42 C.F.R. § 476.85 Conclusive effect of QIO initial denial determinations and changes as a result of DRG validations.
Title 42 - Public Health
A QIO initial denial determination or change as a result of DRG validation is final and binding unless, in accordance with the procedures in part 473— (a) The initial denial determination is reconsidered and revised; or (b) The change as a result of DRG validation is reviewed and revised.
Title 42: Public Health
PART 476—UTILIZATION AND QUALITY CONTROL REVIEW
Subpart C—Review Responsibilities of Utilization and Quality Control Quality Improvement Organizations (QIOs)
QIO Review Functions
§ 476.85 Conclusive effect of QIO initial denial determinations and changes as a result of DRG validations.
