---
kind: "section"
citation: "42 C.F.R. § 412.44"
title: "42"
number: "412.44"
heading: "Medical review requirements: Admissions and quality review."
url: "https://uscodex.org/cfr/42/412.44"
---

# §412.44. Medical review requirements: Admissions and quality review.


Beginning on November 15, 1984, a hospital must have an agreement with a QIO to have the QIO review, on an ongoing basis, the following:

- (a) **The medical necessity, reasonableness and appropriateness of hospital admissions and discharges.**
- (b) The medical necessity, reasonableness and appropriateness of inpatient hospital care for which additional payment is sought under the outlier provisions of §§ [412.82](/cfr/42/412.82.md) and [412.84](/cfr/42/412.84.md) of this chapter.
- (c) **The validity of the hospital's diagnostic and procedural information.**
- (d) **The completeness, adequacy, and quality of the services furnished in the hospital.**
- (e) Other medical or other practices with respect to beneficiaries or billing for services furnished to beneficiaries.

## Notes

### Amendments

[50 FR 15326, Apr. 17, 1985, as amended at 50 FR 35689, Sept. 3, 1985; 50 FR 41886, Oct. 16, 1985]

### Authority

Authority: 42 U.S.C. 1302 and 1395hh.

### Source

Source: 50 FR 12741, Mar. 29, 1985, unless otherwise noted.

### Amendments

[50 FR 15326, Apr. 17, 1985, as amended at 50 FR 35689, Sept. 3, 1985; 50 FR 41886, Oct. 16, 1985]