[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: 42CFR480.136]



[Page 490]

 

                         TITLE 42--PUBLIC HEALTH

 

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

                  HEALTH AND HUMAN SERVICES (CONTINUED)

 

PART 480_ACQUISITION, PROTECTION, AND DISCLOSURE QUALITY IMPROVEMENT 

 

     Subpart B_Utilization and Quality Control Quality Improvement 

                          Organizations (QIOs)

 

Sec.  480.136  Disclosure to intermediaries and carriers.



    (a) Required disclosure. Except as specified in Sec. Sec.  

480.139(a) and 480.140 relating to disclosure of QIO deliberations and 

quality review study information, a QIO must disclose to intermediaries 

and carriers QIO information that relates to, or is necessary for, 

payment of claims for Medicare as follows:

    (1) Review determinations and claims forms for health care services, 

furnished in the manner and form agreed to by the QIO and the 

intermediary or carrier.

    (2) Upon request, copies of medical records acquired from 

practitioners or institutions for review purposes.

    (3) QIO information about a particular patient or practitioner if 

the QIO and the intermediary or carrier (or CMS if the QIO and the 

intermediary or carrier cannot agree) determine that the information is 

necessary for the administration of the Medicare program.

    (b) Optional disclosure. The QIO may disclose the information 

specified in paragraph (a) of this section to intermediaries and 

carriers without a request.



[50 FR 15359, Apr. 17, 1985. Redesignated at 64 FR 66279, Nov. 24, 1999, 

as amended at 69 FR 49267, Aug. 11, 2004]