Federal (United States) · Agency guidance
Chapter 9
82 sections
82 sections
- Quality Improvement Organization Manual (Pub. 100-10), Ch. 9 § 5Day Review
- Quality Improvement Organization Manual (Pub. 100-10), Ch. 9 § 9Fraud and Abuse
- Quality Improvement Organization Manual (Pub. 100-10), Ch. 9 § 9000Introduction and Organization of Sections
- Quality Improvement Organization Manual (Pub. 100-10), Ch. 9 § 9005Authority
- Quality Improvement Organization Manual (Pub. 100-10), Ch. 9 § 9010Definitions Related to Sanctions
- Quality Improvement Organization Manual (Pub. 100-10), Ch. 9 § 9015Roles and Responsibilities
- Quality Improvement Organization Manual (Pub. 100-10), Ch. 9 § 9015.1QIO Role and Responsibilities
- Quality Improvement Organization Manual (Pub. 100-10), Ch. 9 § 9015.1.1QIO Sanction Committee
- Quality Improvement Organization Manual (Pub. 100-10), Ch. 9 § 9015.1.2QIO Sanction Panel
- Quality Improvement Organization Manual (Pub. 100-10), Ch. 9 § 9015.1.3Use of CMS-Designated Case Review System
- Quality Improvement Organization Manual (Pub. 100-10), Ch. 9 § 9015.2CMS Responsibilities
- Quality Improvement Organization Manual (Pub. 100-10), Ch. 9 § 9015.3OIG Responsibilities
- Quality Improvement Organization Manual (Pub. 100-10), Ch. 9 § 9020Identification of Potential Violations
- Quality Improvement Organization Manual (Pub. 100-10), Ch. 9 § 9020.1How Violations Are Initially Identified
- Quality Improvement Organization Manual (Pub. 100-10), Ch. 9 § 9020.2Statutory Obligations – Practitioner’s or Others Person’s Services
- Quality Improvement Organization Manual (Pub. 100-10), Ch. 9 § 9025QIO s – Development of a Sanction Case
- Quality Improvement Organization Manual (Pub. 100-10), Ch. 9 § 9025.1Sanction Committee Initial Review
- Quality Improvement Organization Manual (Pub. 100-10), Ch. 9 § 9025.2Written Notification to Practitioner or Other Person
- Quality Improvement Organization Manual (Pub. 100-10), Ch. 9 § 9030Initial Meeting with Practitioner or Other Person – Requirements
- Quality Improvement Organization Manual (Pub. 100-10), Ch. 9 § 9030.1Composition of the QIO Sanction Panel
- Quality Improvement Organization Manual (Pub. 100-10), Ch. 9 § 9030.2Requirements for the Meeting
- Quality Improvement Organization Manual (Pub. 100-10), Ch. 9 § 9035QIO Sanction Panel – Initial Sanction Recommendation
- Quality Improvement Organization Manual (Pub. 100-10), Ch. 9 § 9035.1QIO Review of Additional Information
- Quality Improvement Organization Manual (Pub. 100-10), Ch. 9 § 9035.2QIO Sanction Panel Determination/Action
- Quality Improvement Organization Manual (Pub. 100-10), Ch. 9 § 9035.3QIO Corrective Action Plan (CAP) Process and Procedures
- Quality Improvement Organization Manual (Pub. 100-10), Ch. 9 § 9035.3.1Corrective Action Plan (CAP) Request
- Quality Improvement Organization Manual (Pub. 100-10), Ch. 9 § 9035.3.2Monitoring a Corrective Action Plan (CAP)
- Quality Improvement Organization Manual (Pub. 100-10), Ch. 9 § 9040QIO Action on Final Finding of a Violation
- Quality Improvement Organization Manual (Pub. 100-10), Ch. 9 § 9040.1Unresolved and Affirmed Findings
- Quality Improvement Organization Manual (Pub. 100-10), Ch. 9 § 9040.2Extenuating Circumstances – Practitioner or Other Person
- Quality Improvement Organization Manual (Pub. 100-10), Ch. 9 § 9040.2.1Practitioner or Other Person – Relocation to Another QIO State
- Quality Improvement Organization Manual (Pub. 100-10), Ch. 9 § 9040.2.2Practitioner or Other Person – Relocation and Referral from
- Quality Improvement Organization Manual (Pub. 100-10), Ch. 9 § 9045QIO Report to Office of Inspector General (OIG)
- Quality Improvement Organization Manual (Pub. 100-10), Ch. 9 § 9045.1Manner of Reporting
- Quality Improvement Organization Manual (Pub. 100-10), Ch. 9 § 9045.1.1Content of Report
- Quality Improvement Organization Manual (Pub. 100-10), Ch. 9 § 9045.1.2QIO Recommendation Report Requirements
- Quality Improvement Organization Manual (Pub. 100-10), Ch. 9 § 9045.2OIG Rejection of QIO Recommendations
- Quality Improvement Organization Manual (Pub. 100-10), Ch. 9 § 9045.3OIG Process –Decision to Sanction
- Quality Improvement Organization Manual (Pub. 100-10), Ch. 9 § 9050OIG Imposition and Notification of Sanction
- Quality Improvement Organization Manual (Pub. 100-10), Ch. 9 § 9050.1Exclusion Sanction
- Quality Improvement Organization Manual (Pub. 100-10), Ch. 9 § 9050.2Monetary Penalty
- Quality Improvement Organization Manual (Pub. 100-10), Ch. 9 § 9050.3Notification to Practitioner or Other Person of OIG Sanction
- Quality Improvement Organization Manual (Pub. 100-10), Ch. 9 § 9050.3.1Written Notice Contents – Specifications
- Quality Improvement Organization Manual (Pub. 100-10), Ch. 9 § 9050.4Patient Notification
- Quality Improvement Organization Manual (Pub. 100-10), Ch. 9 § 9050.4.1Practitioner Elects to Inform Patients
- Quality Improvement Organization Manual (Pub. 100-10), Ch. 9 § 9050.4.2Sanctioned Party Is a Hospital – Notification Requirements
- Quality Improvement Organization Manual (Pub. 100-10), Ch. 9 § 9050.4.3Provider or Other Person Certification Provisions
- Quality Improvement Organization Manual (Pub. 100-10), Ch. 9 § 9050.4.4Notice to Other Interested Parties
- Quality Improvement Organization Manual (Pub. 100-10), Ch. 9 § 9050.5Imposing an Exclusion Sanction – OIG Responsibilities
- Quality Improvement Organization Manual (Pub. 100-10), Ch. 9 § 9055Effect of an Exclusion Sanction on Medicare Payments and
- Quality Improvement Organization Manual (Pub. 100-10), Ch. 9 § 9055.1Payment to an Excluded Practitioner or Other Person –
- Quality Improvement Organization Manual (Pub. 100-10), Ch. 9 § 9055.2Exceptions to Denial of Medicare Payment (Exclusion) –
- Quality Improvement Organization Manual (Pub. 100-10), Ch. 9 § 9055.3CMS Payment to Beneficiaries – Regulatory Requirements
- Quality Improvement Organization Manual (Pub. 100-10), Ch. 9 § 9060Reinstatement after Exclusion by OIG
- Quality Improvement Organization Manual (Pub. 100-10), Ch. 9 § 9065Appeal Rights of the Excluded Practitioner or Other Person
- Quality Improvement Organization Manual (Pub. 100-10), Ch. 9 § 9065.1Appeal Reversal
- Quality Improvement Organization Manual (Pub. 100-10), Ch. 9 § 9065.2Right to Pre-exclusion Preliminary Hearing(s)
- Quality Improvement Organization Manual (Pub. 100-10), Ch. 9 § 9065.3Right to an Administrative Review
- Quality Improvement Organization Manual (Pub. 100-10), Ch. 9 § 9065.4Right to Judicial Review
- Quality Improvement Organization Manual (Pub. 100-10), Ch. 9 § 9100Introduction and Organization of Sections 9100–9135
- Quality Improvement Organization Manual (Pub. 100-10), Ch. 9 § 9105Authority Related to EMTALA
- Quality Improvement Organization Manual (Pub. 100-10), Ch. 9 § 9110Definitions Related to EMTALA Review Activities
- Quality Improvement Organization Manual (Pub. 100-10), Ch. 9 § 9115Hospital Requirements
- Quality Improvement Organization Manual (Pub. 100-10), Ch. 9 § 9120Hospital Penalties for Noncompliance
- Quality Improvement Organization Manual (Pub. 100-10), Ch. 9 § 9125CMS Regional Office Responsibilities
- Quality Improvement Organization Manual (Pub. 100-10), Ch. 9 § 9130QIO 5-Day Review Responsibilities
- Quality Improvement Organization Manual (Pub. 100-10), Ch. 9 § 9130.1Physician Reviewer Selection/Qualifications
- Quality Improvement Organization Manual (Pub. 100-10), Ch. 9 § 9130.2QIO Physician Review Process Description
- Quality Improvement Organization Manual (Pub. 100-10), Ch. 9 § 9135QIO Review Responsibilities – 60-Day Review
- Quality Improvement Organization Manual (Pub. 100-10), Ch. 9 § 9135.1Physician Reviewer Selection/Qualification
- Quality Improvement Organization Manual (Pub. 100-10), Ch. 9 § 9135.2QIO Physician Review Process Description
- Quality Improvement Organization Manual (Pub. 100-10), Ch. 9 § 9135.3Reporting Results of the Review to CMS
- Quality Improvement Organization Manual (Pub. 100-10), Ch. 9 § 9200Scope of QIO Fraud and Abuse Review Activities
- Quality Improvement Organization Manual (Pub. 100-10), Ch. 9 § 9210QIO Review Responsibility
- Quality Improvement Organization Manual (Pub. 100-10), Ch. 9 § 9210.1CMS Approval Process – Referrals to the QIO from Any Source
- Quality Improvement Organization Manual (Pub. 100-10), Ch. 9 § 9210.2QIO Fraud and Abuse Review Process
- Quality Improvement Organization Manual (Pub. 100-10), Ch. 9 § 9220Evaluation Report Requirements
- Quality Improvement Organization Manual (Pub. 100-10), Ch. 9 § 9230Availability of Expert Witness
- Quality Improvement Organization Manual (Pub. 100-10), Ch. 9 § 9230.1Testimony
- Quality Improvement Organization Manual (Pub. 100-10), Ch. 9 § 9230.2Expert Witness Qualifications
- Quality Improvement Organization Manual (Pub. 100-10), Ch. 9 § 9230.3Maintenance of Review Files
- Quality Improvement Organization Manual (Pub. 100-10), Ch. 9 § 9240Reopening of Cases – Regulatory Guidance