42 C.F.R. PART 478--RECONSIDERATIONS AND APPEALS
TITLE 42--Public Health
CHAPTER IV--CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES
SUBCHAPTER F--QUALITY IMPROVEMENT ORGANIZATIONS
PART 478--RECONSIDERATIONS AND APPEALS
Subpart A--[RESERVED]
Subpart B--UTILIZATION AND QUALITY CONTROL QUALITY IMPROVEMENT ORGANIZATION (QIO) RECONSIDERATIONS AND APPEALS
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| QIO review of changes resulting from DRG validation.
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| Right to reconsideration.
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| Location for submitting requests for reconsideration.
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| Time limits for requesting reconsideration.
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| Good cause for late filing of a request for a reconsideration or hearing.
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| Opportunity for a party to obtain and submit information.
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| Delegation of the reconsideration function.
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| Qualifications of a reconsideration reviewer.
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| Evidence to be considered by the reconsideration reviewer.
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| Time limits for issuance of the reconsidered determination.
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| Notice of a reconsidered determination.
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| Record of reconsideration.
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| Effect of a reconsidered determination.
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| Beneficiary's right to a hearing.
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| Submitting a request for a hearing.
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| Determining the amount in controversy for a hearing.
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| Departmental Appeals Board and judicial review.
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| Reopening and revision of a reconsidered determination or a hearing decision.
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