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42 C.F.R. PART 476--UTILIZATION AND QUALITY CONTROL REVIEW

TITLE 42--Public Health

CHAPTER IV--CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES

SUBCHAPTER F--QUALITY IMPROVEMENT ORGANIZATIONS

PART 476--UTILIZATION AND QUALITY CONTROL REVIEW

Subpart A--GENERAL PROVISIONS

�476.1

Definitions.

Subpart B--[RESERVED]

Subpart C--REVIEW RESPONSIBILITIES OF UTILIZATION AND QUALITY CONTROL QUALITY IMPROVEMENT ORGANIZATIONS (QIOS)

�476.70

Statutory bases and applicability.

�476.71

QIO review requirements.

�476.72

Review of the quality of care of risk-basis health maintenance organizations and competitive medical plans.

�476.73

Notification of QIO designation and implementation of review.

�476.74

General requirements for the assumption of review.

�476.76

Cooperation with health care facilities.

�476.78

Responsibilities of health care facilities.

�476.80

Coordination with Medicare fiscal intermediaries and carriers.

�476.82

Continuation of functions not assumed by QIOs.

�476.83

Initial denial determinations.

�476.84

Changes as a result of DRG validation.

�476.85

Conclusive effect of QIO initial denial determinations and changes as a result of DRG validations.

�476.86

Correlation of Title XI functions with Title XVIII functions.

�476.88

Examination of the operations and records of health care facilities and practitioners.

�476.90

Lack of cooperation by a health care facility or practitioner.

�476.93

Opportunity to discuss proposed initial denial determination and changes as a result of a DRG validation.

�476.94

Notice of QIO initial denial determination and changes as a result of a DRG validation.

�476.96

Review period and reopening of initial denial determinations and changes as a result of DRG validations.

�476.98

Reviewer qualifications and participation.

�476.100

Use of norms and criteria.

�476.102

Involvement of health care practitioners other than physicians.

�476.104

Coordination of activities.