ClearCore Insight recently hosted a virtual conversation on “How Delaying CMS-0057-F Compliance Could Cost You Millions,” healthcare executives explored the potential impacts of postponing CMS-0057-F compliance, revealing significant risks for payers, providers, and the broader healthcare ecosystem. This discussion highlighted the critical need for proactive action, not only to avoid penalties but also to ensure long-term organizational stability.
Understanding the Compliance Gap
One of the recurring themes was the widespread underestimation of the CMS-0057-F mandate. As one speaker noted, “They know it’s on the roadmap, but that’s not today’s problem.” This reflects a mindset that is fixated on short-term survival, with many organizations focused on the immediate challenges of staffing and resource management, especially through the first quarter of 2025.
However, based off results from a poll that was completed, most participants indicated their organizations are in the early stages of preparation, with 42% reporting they are not at all prepared and 50% just starting to address compliance. Only 8% felt somewhat prepared but recognized there is still a long way to go.
The urgency of compliance is rapidly approaching, and delaying action could lead to a flood of last-minute efforts, driving up the cost of resources and creating chaos within healthcare systems. One participant emphasized, “All the vendors are going to get slammed to try and comply, and they’re not going to have the availability because the resources are someplace else.” This shortage of qualified resources will result in skyrocketing consultancy fees and increased operational pressure.
The Top Risks of Delaying Compliance
The results from the poll also highlighted the top risks of delaying compliance, including:
- Over-reliance on third-party vendors (67%) – Concerns were raised about vendors’ responsiveness and timely software updates, which could cause delays.
- Regulatory fines and penalties (53%) – Organizations face significant financial risks if they do not meet the CMS deadlines.
- Missed opportunities for operational efficiencies (53%) – Delaying could prevent organizations from streamlining their processes and gaining a competitive advantage.
The consensus from the poll was clear: Acting now is not just about avoiding penalties—it’s about positioning your organization for success. Delaying compliance will lead to operational disruptions, financial penalties, and lost opportunities for efficiency gains.
Stakeholder Engagement: A Key to Success
A major challenge identified was the lack of stakeholder engagement across organizations. Many executives struggle to align internal teams around the urgency of CMS-0057-F. One speaker pointed out, “How do you line all your stakeholders? How do you get them engaged?” Without cross-departmental collaboration, particularly between procurement, legal, compliance, and IT, organizations will face significant obstacles in executing their compliance strategies.
Moreover, CMS-0057-F isn’t just an IT issue; it affects every layer of an organization, including clinical operations, risk adjustment, and provider relations. Another participant added, “You can’t have one person running the show. It’s really about working across the verticals.” Building alignment at both the leadership and operational levels is crucial to successful implementation.
Financial Consequences of Delay
Perhaps the most alarming takeaway from the conversation was the financial fallout organizations may face if they fail to comply in time. The potential costs go beyond regulatory fines and extend into operational inefficiencies, vendor penalties, and reputational damage. As one speaker warned, “If they don’t achieve compliance, it could end their business.”
Consultants echoed this sentiment, noting that last-minute attempts to outsource compliance work would come at a premium, with some vendors already signaling price hikes due to increased demand. “By 2027, consultants will be making a boatload, because organizations that missed the boat will be scrambling,” one expert remarked. These high costs could place organizations at severe financial risk, especially if they are already operating on tight margins.
The Time to Act is Now
The panel made it clear that while time remains to implement CMS-0057-F, the window for taking strategic, cost-effective actions is rapidly closing. Health plans, especially those with complex IT ecosystems, must start laying the groundwork immediately. As one speaker advised, “Health plans should really be compliant, or at least implemented, by Q1 of 2026, because they’re going to need six or more months to reach quality-driven metrics and meet KPIs.”
By waiting too long, organizations risk facing a chaotic implementation process, leading to poor outcomes for patients and strained relationships with providers. The discussion repeatedly circled back to the notion that proactive planning, stakeholder engagement, and realistic budget allocations are the only ways to ensure smooth compliance.
CMS-0057-F as a Transformative Opportunity
While CMS-0057-F presents significant challenges, it also offers healthcare organizations an opportunity for transformation. Those who approach compliance as a chance to streamline operations and improve provider relationships will be in a far stronger position. As one panelist optimistically put it, “This is transformative. It’s going to create massive new efficiencies for both payers and providers.”
For organizations ready to embrace change, CMS-0057-F compliance could lead to improved workflows, better use of data, and long-term operational success. However, those who delay are likely to face steep costs—both financially and reputationally—as they scramble to meet requirements at the last minute.
The conversation underscored that CMS-0057-F compliance isn’t just a box to check; it’s a pivotal moment for healthcare organizations to evolve and thrive. The time to act is now.
