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Code of Federal Regulations (Last Updated: May 6, 2024) |
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Title 42 - Public Health |
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Chapter IV - Centers for Medicare & Medicaid Services, Department of Health and Human Services |
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SubChapter F - Quality Improvement Organizations |
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Part 476 - Quality Improvement Organization Review |
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Subpart C - Review Responsibilities of Quality Improvement Organizations (QIOs) |
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QIO Review Functions |
§ 476.85 - Conclusive effect of QIO initial denial determinations and changes as a result of DRG validations.
Latest version.
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§ 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.