§ 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 Medicare Appeals Council and judicial review
§ 478.48 Reopening and revision of a reconsidered determination or a decision

Terms Used In CFR > Title 42 > Chapter IV > Subchapter F > Part 478 > Subpart B - Utilization and Quality Control Quality Improvement Organization (Qio) Reconsiderations and Appeals

  • 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
  • Dismissal: The dropping of a case by the judge without further consideration or hearing. Source:
  • 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.
  • Litigation: A case, controversy, or lawsuit. Participants (plaintiffs and defendants) in lawsuits are called litigants.