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US · guidance

CMS Pub. 100-04, ch. 30, § 300

Expedited Reconsiderations

activein force · 2026-08-25 – presentas-observed

A beneficiary who is dissatisfied with a QIO determination can request a reconsideration

by an independent review entity (IRE). Such reconsiderations are codified in regulations

effective July 1, 2005 (42 CFR 405.1204) but are familiar to inpatient hospital providers

as the process previously available under §1155 of the Act. This reconsideration process

is the same for hospital and non-hospital providers.

History

(Rev. 1257, Issued: 05-25-07; Effective: 07-01-07; Implementation: 07-02-07)

Provenance

Source
cms.gov
Retrieved
2026-08-25
Edition
iom-2026-08-25
Content hash
22eec27985eb9736d49caa1ae379cd202b314c7ff46e762ac3d512f07ca03a72
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