[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: 42CFR478.10]



[Page 476]

 

                         TITLE 42--PUBLIC HEALTH

 

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

                  HEALTH AND HUMAN SERVICES (CONTINUED)

 

PART 478_RECONSIDERATIONS AND APPEALS--Table of Contents

 

     Subpart B_Utilization and Quality Control Quality Improvement 

             Organization (QIO) Reconsiderations and Appeals

 

Sec.  478.10  Scope.



    Source: 50 FR 15372, Apr. 17, 1985, unless otherwise noted. 

Redesignated at 64 FR 66279, Nov. 24, 1999.





    This subpart establishes the requirements and procedures for--

    (a) Reconsiderations conducted by a Utilization and Quality Control 

Quality Improvement Organization (QIO) or its subcontractor of initial 

denial determinations concerning services furnished or proposed to be 

furnished under Medicare;

    (b) Hearings and judicial review of reconsidered determinations; and

    (c) QIO review of a change in diagnostic and procedural coding 

information.



[50 FR 15372, Apr. 17, 1985; 50 FR 41887, Oct. 16, 1985. Redesignated at 

64 FR 66279, Nov. 24, 1999]