PRRB Dec. No. 2007-D49

1. Whether the exception review process engaged in by the Health Care Financing Administration (HCFA) and the Fiscal Intermediary violated due process and fundamental fairness, including violations of the time limits established by federal regulation and the Provider Reimbursement Manual so as to cause the exception request to be deemed approved in full. 2. Whether HCFA and the Fiscal Intermediary improperly denied the Tax Equity and Fiscal Responsibility Act (TEFRA) adjustment in its entirety, when at a minimum Oregon Medical Professional Review Organizations (OMPROs) independent medical review supported a reduced exception amount. 3. Whether HCFA and the Fiscal Intermediary erred in denying the Provider's revised TEFRA exception request without correcting the Intermediary's use of an incorrect TEFRA target rate.