U.S. Code of Federal Regulations

Regulations most recently checked for updates: Aug 27, 2025

All TitlesTitle 42Chapter IVPart 478Subpart B - Subpart B—Utilization and Quality Control Quality Improvement Organization (QIO) Reconsiderations and Appeals
§ 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.
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