SUBPART B—Utilization and Quality Control Quality Improvement Organization (QIO) Reconsiderations and Appeals (§478.10 to §478.48)
- 478.10—Scope.
- 478.12—Statutory basis.
- 478.14—Applicability.
- 478.15—QIO review of changes resulting from DRG validation.
- 478.16—Right to reconsideration.
- 478.18—Location for submitting requests for reconsideration.
- 478.20—Time limits for requesting reconsideration.
- 478.22—Good cause for late filing of a request for a reconsideration or hearing.
- 478.24—Opportunity for a party to obtain and submit information.
- 478.26—Delegation of the reconsideration function.
- 478.28—Qualifications of a reconsideration reviewer.
- 478.30—Evidence to be considered by the reconsideration reviewer.
- 478.32—Time limits for issuance of the reconsidered determination.
- 478.34—Notice of a reconsidered determination.
- 478.36—Record of reconsideration.
- 478.38—Effect of a reconsidered determination.
- 478.40—Beneficiary's right to a hearing.
- 478.42—Submitting a request for a hearing.
- 478.44—Determining the amount in controversy for a hearing.
- 478.46—Departmental Appeals Board and judicial review.
- 478.48—Reopening and revision of a reconsidered determination or a hearing decision.