2004 CFR Title 42, Volume 3

Title 42--Public Health CHAPTER IV--CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) PART 476--UTILIZATION AND QUALITY CONTROL REVIEW
	476.1	Definitions.
	476.70	Statutory bases and applicability.
	476.71	QIO review requirements.
	476.72	Review of the quality of care of risk-basis health maintenance organizations and competitive medical plans.
	476.73	Notification of QIO designation and implementation of review.
	476.74	General requirements for the assumption of review.
	476.76	Cooperation with health care facilities.
	476.78	Responsibilities of health care facilities.
	476.80	Coordination with Medicare fiscal intermediaries and carriers.
	476.82	Continuation of functions not assumed by QIOs.
	476.83	Initial denial determinations.
	476.84	Changes as a result of DRG validation.
	476.85	Conclusive effect of QIO initial denial determinations and changes as a result of DRG validations.
	476.86	Correlation of Title XI functions with Title XVIII functions.
	476.88	Examination of the operations and records of health care facilities and practitioners.
	476.90	Lack of cooperation by a health care facility or practitioner.
	476.93	Opportunity to discuss proposed initial denial determination and changes as a result of a DRG validation.
	476.94	Notice of QIO initial denial determination and changes as a result of a DRG validation.
	476.96	Review period and reopening of initial denial determinations and changes as a result of DRG validations.
	476.98	Reviewer qualifications and participation.
	476.100	Use of norms and criteria.
	476.102	Involvement of health care practitioners other than physicians.
	476.104	Coordination of activities.