QIO Review Functions

  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

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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.