Statutes, codes, and regulations
Code of Federal Regulations
Title 42 - PUBLIC HEALTHChapter IV - CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICESSubchapter F - QUALITY IMPROVEMENT ORGANIZATIONSPart 476 - QUALITY IMPROVEMENT ORGANIZATION REVIEWSubpart C - REVIEW RESPONSIBILITIES OF QUALITY IMPROVEMENT ORGANIZATIONS (QIOS)
QIO REVIEW FUNCTIONS
Section 476.85 - Conclusive effect of QIO initial denial determinations and changes as a result of DRG validations

42 C.F.R. § 476.85

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Current through May 31, 2024
Section 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.

42 C.F.R. §476.85