CFR > Title 42 - Public Health > CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES > SUBCHAPTER F—QUALITY IMPROVEMENT ORGANIZATIONS (parts 475 to 481) > PART 476—UTILIZATION AND QUALITY CONTROL REVIEW > SUBPART C—Review Responsibilities of Utilization and Quality Control Quality Improvement Organizations (QIOs) (§476.70 to §476.104) > 476.85—Conclusive effect of QIO initial denial determinations and changes as a result of DRG validations.

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

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.