Subpart C. Subpart C—Review Responsibilities of Quality Improvement Organizations (QIOs)

• General Provisions

  • SECTION § 476.70 - Statutory bases and applicability.
  • SECTION § 476.71 - QIO review requirements.
  • SECTION § 476.73 - Notification of QIO designation and implementation of review.
  • SECTION § 476.74 - General requirements for the assumption of review.
  • SECTION § 476.76 - Cooperation with health care facilities.
  • SECTION § 476.78 - Responsibilities of providers and practitioners.
  • SECTION § 476.80 - Coordination with Medicare administrative contractors, fiscal intermediaries, and carriers
  • SECTION § 476.82 - Continuation of functions not assumed by QIOs.

• QIO Review Functions

  • SECTION § 476.83 - Initial denial determinations.
  • SECTION § 476.84 - Changes as a result of DRG validation.
  • SECTION § 476.85 - Conclusive effect of QIO initial denial determinations and changes as a result of DRG validations.
  • SECTION § 476.86 - Correlation of Title XI functions with Title XVIII functions.
  • SECTION § 476.88 - Examination of the operations and records of health care facilities and practitioners.
  • SECTION § 476.90 - Lack of cooperation by a provider or practitioner.
  • SECTION § 476.93 - Opportunity to discuss proposed initial denial determination and changes as a result of a DRG validation.
  • SECTION § 476.94 - Notice of QIO initial denial determination and changes as a result of a DRG validation.
  • SECTION § 476.96 - Review period and reopening of initial denial determinations and changes as a result of DRG validations.
  • SECTION § 476.98 - Reviewer qualifications and participation.
  • SECTION § 476.100 - Use of norms and criteria.
  • SECTION § 476.102 - Involvement of health care practitioners other than physicians.
  • SECTION § 476.104 - Coordination of activities.
  • SECTION § 476.110 - Use of immediate advocacy to resolve oral beneficiary complaints.
  • SECTION § 476.120 - Submission of written beneficiary complaints.
  • SECTION § 476.130 - Beneficiary complaint review procedures.
  • SECTION § 476.140 - Beneficiary complaint reconsideration procedures.
  • SECTION § 476.150 - Abandoned complaints and reopening rights.
  • SECTION § 476.160 - General quality of care review procedures.
  • SECTION § 476.170 - General quality of care reconsideration procedures.