§ 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 provider 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
§ 476.110 Use of immediate advocacy to resolve oral beneficiary complaints
§ 476.120 Submission of written beneficiary complaints
§ 476.130 Beneficiary complaint review procedures
§ 476.140 Beneficiary complaint reconsideration procedures
§ 476.150 Abandoned complaints and reopening rights
§ 476.160 General quality of care review procedures
§ 476.170 General quality of care reconsideration procedures

Terms Used In CFR > Title 42 > Chapter IV > Subchapter F > Part 476 > Subpart C > QIO Review Functions

  • Answer: The formal written statement by a defendant responding to a civil complaint and setting forth the grounds for defense.
  • Appeal: A request made after a trial, asking another court (usually the court of appeals) to decide whether the trial was conducted properly. To make such a request is "to appeal" or "to take an appeal." One who appeals is called the appellant.
  • Beneficiary: A person who is entitled to receive the benefits or proceeds of a will, trust, insurance policy, retirement plan, annuity, or other contract. Source: OCC
  • Complaint: A written statement by the plaintiff stating the wrongs allegedly committed by the defendant.
  • Contract: A legal written agreement that becomes binding when signed.
  • Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
  • Fraud: Intentional deception resulting in injury to another.
  • Grace period: The number of days you'll have to pay your bill for purchases in full without triggering a finance charge. Source: Federal Reserve
  • Guardian: A person legally empowered and charged with the duty of taking care of and managing the property of another person who because of age, intellect, or health, is incapable of managing his (her) own affairs.
  • Remainder: An interest in property that takes effect in the future at a specified time or after the occurrence of some event, such as the death of a life tenant.
  • Statute: A law passed by a legislature.