Utilization and Quality Control Quality Improvement Organization (QIO) Reconsiderations and Appeals

  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. Reconsiderations and Appeals
  7. Utilization and Quality Control Quality Improvement Organization (QIO) Reconsiderations and Appeals

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Section
478.10

Scope.

Section
478.12

Statutory basis.

Section
478.14

Applicability.

Section
478.15

QIO review of changes resulting from DRG validation.

Section
478.16

Right to reconsideration.

Section
478.18

Location for submitting requests for reconsideration.

Section
478.20

Time limits for requesting reconsideration.

Section
478.22

Good cause for late filing of a request for a reconsideration or hearing.

Section
478.24

Opportunity for a party to obtain and submit information.

Section
478.26

Delegation of the reconsideration function.

Section
478.28

Qualifications of a reconsideration reviewer.

Section
478.30

Evidence to be considered by the reconsideration reviewer.

Section
478.32

Time limits for issuance of the reconsidered determination.

Section
478.34

Notice of a reconsidered determination.

Section
478.36

Record of reconsideration.

Section
478.38

Effect of a reconsidered determination.

Section
478.40

Beneficiary's right to a hearing.

Section
478.42

Submitting a request for a hearing.

Section
478.44

Determining the amount in controversy for a hearing.

Section
478.46

Medicare Appeals Council and judicial review.

Section
478.48

Reopening and revision of a reconsidered determination or a decision.