[Code of Federal Regulations]

[Title 42, Volume 4]

[Revised as of October 1, 2006]

From the U.S. Government Printing Office via GPO Access

[CITE: 42CFR476.85]



[Page 471]

 

                         TITLE 42--PUBLIC HEALTH

 

  CHAPTER IV--CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF 

                  HEALTH AND HUMAN SERVICES (CONTINUED)

 

PART 476_UTILIZATION AND QUALITY CONTROL REVIEW--Table of Contents

 

  Subpart C_Review Responsibilities of Utilization and Quality Control 

                Quality Improvement Organizations (QIOs)

 

Sec.  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.