Revocation is the right of the patient.  CMS allows an individual or representative to revoke the election of hospice care at any time in writing. To revoke the election of hospice care, the individual must file a document with the hospice that includes a signed statement that the individual revokes the election for Medicare coverage of hospice care for the remainder of that election period and the effective date of that revocation.

A hospice may discharge the patient, per guidelines for discharge found at 418.26 but may not revoke the patient.

Revocation key points:

• Once a hospice chooses to admit a Medicare beneficiary, it may not automatically or routinely discharge the beneficiary at its discretion, even if the care promises to be costly or inconvenient, or the State allows for discharge under State requirements. The election of the hospice benefit is the beneficiary’s choice rather than the hospice’s choice, and the hospice cannot revoke the beneficiary’s election. Neither should the hospice request or demand that the patient revoke his/her election.
• A verbal revocation of benefits is NOT acceptable.
• The individual forfeits hospice coverage for any remaining days in that election period
• An individual may not designate an effective date earlier than the date that the revocation is made. 
• Upon revoking the election of Medicare coverage of hospice care for a particular election period, an individual resumes Medicare coverage of the benefits waived when hospice care was elected.
• An individual may at any time elect to receive hospice coverage.
• Managed care enrollees who have elected hospice may revoke hospice election at any time, but claims will continue to be paid by fee-for-service contractors as if the beneficiary were a fee-for-service beneficiary until the first day of the month following the month in which hospice was revoked.  By regulation, the duration of payment responsibility by fee-for-service contractors extends through the remainder of the month in which hospice is revoked by hospice beneficiaries.

The Regulations:  §418.28  Revoking the election of hospice care

CR 7677 - New Hospice Condition Code for Out of Service Area Discharges (FEB 3, 2012)

Effective for dates of service on or after July 1, 2012, Medicare is requiring hospices to discontinue use of occurrence code 42 for situations when a provider initiates the termination of hospice care and only use occurrence code 42 to indicate a discharge due to a patient revocation.