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Healthcare Reporting and Regulatory Returns

Returns are usually assembled by hand from several systems. What to capture at source so the report is a query rather than a project.

Updated 2 min readBy SpiderHunts Technologies

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Quick answer — TL;DR

If a return is assembled by hand every period, the data is probably not being captured in the form the return needs. Capture it at source with the definitions the return uses, and the report becomes a query.

The short answer

Work backwards from the return. Which fields does it need, at what granularity, with what definitions? Then check whether your systems capture that. Usually one or two fields are missing or captured differently, and that is what forces the manual assembly.

Fixing the capture is a smaller job than the recurring reconstruction, and it makes the number defensible.

Why returns get assembled by hand

  • A required field is not captured, so it is inferred
  • Definitions differ between the return and the operational system
  • Data sits in several systems that do not join cleanly
  • The return needs a point-in-time view and the system holds current state
  • Exclusions and adjustments are applied by someone who knows the rules

The fourth is the most structural. A return asking what the position was on a date cannot be answered by a system that overwrites, which is an architecture decision rather than a reporting one.

Capture definitions at source

Instead ofDo this
Deriving a category at report timeCapture it when the event happens
Inferring a date from another fieldRecord the date the return asks for
Applying exclusions manuallyRecord the exclusion reason as data
Reconstructing a past stateKeep history rather than overwriting

The bottom row is the expensive one to retro-fit and the most valuable to get right early.

Make it reproducible

  1. Generate the return from a query, not a spreadsheet.
  2. Version the query alongside the definitions it implements.
  3. Store the submitted figures with the date and the query version.
  4. Keep the underlying rows so a challenged figure can be explained.
  5. Re-run a previous period and check it reproduces.

Point five is the test. If last quarter's figure cannot be reproduced today, the process is not reproducible and a query about it cannot be answered confidently.

Reconcile before submitting

Build the checks into the process: totals against the operational system, period-on-period comparison, and flags on anything outside a normal range.

Most submission errors are visible in a comparison against the previous period. Catching them before submission is considerably easier than correcting afterwards.

FAQ

Frequently asked questions

The questions readers ask us after this guide.

Still have a question?

Ask us directly — a senior engineer will get back to you.

Ask about your project

Why do our returns take so long?

Usually because a field the return needs is not captured, or is captured under a different definition, so it gets reconstructed each time.

Can returns be fully automated?

Largely, once capture matches the definitions. Expect a review step before submission regardless.

What if the return needs a historical position?

That requires keeping history rather than current state, which is an architectural decision best made early.

How do we defend a figure that is challenged?

Keep the underlying rows, the query version and the date. Without those, the answer is a reconstruction rather than a record.

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