Subpart A - General Provisions

§ 466.1 - Definitions.

Subpart C - Review Responsibilities of Utilization and Quality Control Peer Review Organizations (PROs)

PRO Review Functions

§ 466.83 - Initial denial determinations.

§ 466.84 - Changes as a result of DRG validation.

§ 466.85 - Conclusive effect of PRO initial denial determinations and changes as a result of DRG validations.

§ 466.86 - Correlation of Title XI functions with Title XVIII functions.

§ 466.88 - Examination of the operations and records of health care facilities and practitioners.

§ 466.90 - Lack of cooperation by a health care facility or practitioner.

§ 466.93 - Opportunity to discuss proposed initial denial determination and changes as a result of a DRG validation.

§ 466.94 - Notice of PRO initial denial determination and changes as a result of a DRG validation.

§ 466.96 - Review period and reopening of initial denial determinations and changes as a result of DRG validations.

§ 466.98 - Reviewer qualifications and participation.

§ 466.100 - Use of norms and criteria.

§ 466.102 - Involvement of health care practitioners other than physicians.

§ 466.104 - Coordination of activities.

General Provisions

§ 466.70 - Statutory bases and applicability.

§ 466.71 - PRO review requirements.

§ 466.72 - Review of the quality of care of risk-basis health maintenance organizations and competitive medical plans.

§ 466.73 - Notification of PRO designation and implementation of review.

§ 466.74 - General requirements for the assumption of review.

§ 466.76 - Cooperation with health care facilities.

§ 466.78 - Responsibilities of health care facilities.

§ 466.80 - Coordination with Medicare fiscal intermediaries and carriers.

§ 466.82 - Continuation of functions not assumed by PROs.