CMS Pub. 100-04, ch. 3, § 170.1.1

The RNHCI benefit provides only for Part A inpatient services. For an RNHCI to receive

payment under the Medicare program, the beneficiary must make a written election to

receive benefits under §1821 of the Act. To elect religious nonmedical health care

services, the beneficiary or the beneficiary’s legal representative must attest that the

individual is conscientiously opposed to acceptance of nonexcepted medical treatment,

and the individual’s acceptance of such treatment would be inconsistent with the

individual’s sincere religious beliefs.

All submissions regarding RNHCI services are processed by a single Medicare contractor

as a specialty workload. Currently, this specialty workload is part of Medicare

Administrative Contractor Jurisdiction 10. The completed election form must be filed

with the contractor and a copy retained by the RNHCI provider. See section 170.1.3

below for instructions on the submission of the election to the contractor.

The RNHCI provider should question each beneficiary prior to executing the election

statement to determine if the beneficiary has Medicare Part B coverage in effect via a

health plan or has recently received care (services or items, including physician-ordered

durable medical equipment) for which Medicare payment was sought. An affirmative

answer will alert the RNHCI provider that subsequent claims under the election may be

denied.

Occasionally, a Medicare beneficiary may seek services at a RNHCI that do not qualify

for Medicare coverage and for which the beneficiary may seek payment from another

insurer. The beneficiary is not required to make an election of RNHCI benefits in this

case.

If the other insurer requires a denial from Medicare before making payment for these

services, a denial notice cannot be processed by Medicare claims processing systems.

Medicare systems require submission of a Notice of Election (NOE) before any RNHCI

claims, including claims for denial, can be processed.

The RNHCI may request in writing a denial notice from the Medicare contractor. The

written request must describe the reason the beneficiary does not qualify for Medicare

coverage. It must also describe the specific services that will be provided to the

beneficiary. In response, the contractor will provide the RNHCI with a manual denial

letter. This letter may then be submitted to a secondary insurer as evidence of a prior

Medicare denial.