412.44—Medical review requirements: Admissions and quality review.
Beginning on November 15, 1984, a hospital must have an agreement with a QIO to have the QIO review, on an ongoing basis, the following:
(a)
The medical necessity, reasonableness and appropriateness of hospital admissions and discharges.
(b)
The medical necessity, reasonableness and appropriateness of inpatient hospital care for which additional payment is sought under the outlier provisions of §§ 412.82 and 412.84 of this chapter.
(e)
Other medical or other practices with respect to beneficiaries or billing for services furnished to beneficiaries.
[50 FR 15326, Apr. 17, 1985, as amended at 50 FR 35689, Sept. 3, 1985; 50 FR 41886, Oct. 16, 1985]