SUBPART C—Review Responsibilities of Utilization and Quality Control Quality Improvement Organizations (QIOs) (§476.70 to §476.104)
- 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.