CMS Pub. 100-10, ch. 9, § 9135.2.1

The timeframe is as follows:

Calendar Day 1: The QIO receives the record from the CMS Regional Office DSC.

Calendar Day 15: Notify the involved hospital and, if appropriate, the involved physician

via certified letter, return receipt requested. The letter should inform the hospital and/or

physician that the QIO is reviewing the case as well as the opportunity to discuss the case

(in person or by phone). Inform the hospital/physician that they may submit additional

information within 30 calendar days of receiving the letter. (See Appendix 9-16, 60-Day

QIO Review-Opportunity for Discussion Model Letter.)

The letter must also contain:

• The name of each individual who is the subject of the violation;

• The date on which each violation occurred;

• A statement that the rights to discuss the case and provide additional information

will be waived if the invitation is not accepted; and

• A copy of 42 CFR §489.24.

When a meeting is scheduled, notify the Regional Office DSC and OIG of the time and

date.

Calendar Day 20: The above letter(s) is (are) presumed to have been received by the

hospital and/or physician.

Calendar Day 50: Discussion and hospital/physician submission of data, if desired, is

complete.

Calendar Day 60: The QIO completes the review. The Regional Office DSC must receive

the QIO final physician review and report (facsimile or through a secure electronic system

approved by CMS) no later than close of business on calendar day 60. If submitted

electronically, a signed hard copy must be sent to the DSC by mail. The QIO 60-day

report must contain:

• The name of the hospital or physician (or both, where applicable);

• The name of the individual and the dates and times the individual arrived at and

was transferred (or discharged) from the hospital; and

• The completed QIO physician review worksheet.

NOTE: Do not state an opinion or conclusion about whether a violation has occurred.