GroundRules
42 CFR 476.85: Conclusive effect of QIO initial denial determinations and changes as a result of DRG validations.
Where this section sits in the code
- Title 42—Public Health
- CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES
- SUBCHAPTER F—QUALITY IMPROVEMENT ORGANIZATIONS
- PART 476—QUALITY IMPROVEMENT ORGANIZATION REVIEW
- Subpart C—Review Responsibilities of Quality Improvement Organizations (QIOs)
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.
Collected 2026-08-27T02:26:11Z. Source file · JSON