PROMPT Act Mandates Medicare Explanation of Benefits Be Sent Within 30 Days of Payment

The new PROMPT Act—officially the Prompt Reporting and Oversight for Medicare Providing Transparency Act—is taking aim at the notoriously slow pace of Medicare paperwork. Specifically, this bill amends the Social Security Act to require the Secretary of Health and Human Services (HHS) to deliver an Explanation of Benefits (EOB) to Medicare beneficiaries no later than 30 days after the payment for a covered item or service is actually made. This is a simple but potentially significant change designed to speed up the flow of information from the government to the patient.

Cutting the Paperwork Wait Time

For anyone who has ever waited months for a medical bill or EOB, you know the anxiety that comes with not knowing what was covered, what wasn’t, and whether you owe more money. This delay is a huge headache for Medicare recipients, who often need that EOB to track their spending, confirm coverage, or spot potential errors. The PROMPT Act, by setting a clear 30-day clock (Section 2), aims to give patients better visibility into their medical finances, faster. Think of it as forcing CMS to use the express lane for sending out the receipts.

Why the 30-Day Deadline Matters

This provision is a win for transparency. When EOBs arrive quickly, beneficiaries gain a crucial advantage: the ability to detect billing errors or potential fraud while the details are still fresh. If your EOB shows a payment for a service you didn't receive last month, you can flag it immediately. Waiting 60 or 90 days makes that detective work much harder. For the millions of seniors managing fixed incomes, knowing exactly what Medicare paid and what their remaining liability is within a month helps immensely with budgeting and financial planning, allowing them to pay their share or contest charges without unnecessary delay.

The Administrative Lift for CMS

While this is great news for the patient, it means a significant administrative push for the Centers for Medicare & Medicaid Services (CMS). Mandating a 30-day turnaround after payment requires robust, efficient, and potentially upgraded payment processing and mailing systems. If current systems are prone to backlogs or delays, meeting this hard deadline consistently will be a challenge, requiring HHS to invest resources into compliance. However, the clarity of the requirement—30 days post-payment—leaves little room for interpretation, which is often the best way to drive bureaucratic efficiency.