How a resident becomes RT-eligible
- Present in the building on the day of service
- At least one active ICD-10 diagnosis on the facility’s RT-eligible list
- An eligible primary payer and active Medicare Part B
- No active Medicare Advantage plan, unless the plan is on your facility’s exception list
What the daily eligibility report shows
- Residents who qualify but have no active RT orders
- Residents with an evaluate-and-treat order waiting on an evaluation
- Residents whose eligibility changed and should stop therapy
- Complementary orders residents typically need, such as pulse oximetry alongside chest wall manipulation
- Medicare Advantage disenrollments that make a resident newly eligible
Frequently asked questions
What diagnoses qualify for respiratory therapy under Medicare Part B?
It depends on your Medicare Administrative Contractor. Noridian, Novitas, and Palmetto each publish the respiratory diagnoses they accept. Common examples include COPD, chronic respiratory failure, and pneumonia-related conditions. CareComply applies your contractor’s list automatically.
Can Medicare Advantage residents receive Part B RT?
Generally not billed as straight Part B. A resident on an active Medicare Advantage plan is ineligible unless the facility has an arrangement with that plan. When a resident disenrolls from Medicare Advantage, our report flags them as newly eligible.
Sources
Review status: Pending compliance review