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

  1. Law
  2. CFR 42
  3. Public Health
  4. Centers for Medicare & Medicaid Services, Department of Health and Human Services
  5. Quality Improvement Organizations
  6. Quality Improvement Organization Review
  7. Review Responsibilities of Quality Improvement Organizations (QIOs)
  8. QIO Review Functions
  9. Conclusive effect of QIO initial denial determinations and changes as a result of DRG validations.

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§ 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.


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