The Medical Screening & Intake Manual

Part 1 — What this manual is and is not

Screening a birth injury inquiry has two halves that get conflated, usually to the detriment of both.

The reason the distinction matters commercially: the left column is where almost all of the recoverable loss sits. Firms lose far more viable matters to an unowned records chase than to a wrong clinical call.

Part 2 — The capacity model

Weekly review capacity equals reviewer hours available, times a realistic utilisation, divided by hours per review. Three inputs, all of which must be measured rather than estimated, because all three are optimistic in the same direction when estimated.

Once you have the ceiling, the queue behaves predictably. If weekly demand exceeds it, the backlog grows linearly and without limit, and every inquiry in it ages. Ageing costs contactability, costs matters to competitors, and in some matters raises a limitation exposure. The planner models it.

Part 3 — The intake call

The intake call has one job: gather enough to decide whether records are worth obtaining, without assessing merit and without saying anything about value. It has a second, unstated job, which is to leave a distressed person feeling that someone competent is now involved.

Grade a real call against the twelve-criterion rubric.

Part 4 — The records workflow

This is the least glamorous part of the system and the one that recovers the most value. Records requests are where matters the firm has already paid to acquire quietly die.

Run an ageing report weekly. One query: every open inquiry, its stage, and how many days it has sat there. The oldest item on that report is the finding. It is almost always older than anyone in the firm believes, and it is almost always stuck at "authorisation returned" or "provider acknowledgement".

Part 5 — The quality audit

A screening rubric that is too tight throws away viable matters, and it does so invisibly, because nobody follows up a rejection. The audit is the only mechanism that catches it.

1. Each quarter, draw a random sample of screened-out inquiries — twenty is enough to be informative.
2. Have them re-reviewed by someone who did not make the original decision, ideally the firm’s clinical reviewer.
3. Record disagreements and, more importantly, the reason category of each disagreement.
4. If disagreements cluster in one reason category, the rubric is wrong in a specific way and can be fixed.

Part 6 — What this manual does not cover

Stated explicitly, because the omission is the honest part of this document.

• Clinical criteria. What in a set of records indicates a departure from the standard of care is a clinical and legal question. It is not in here, it will not be in here, and any marketing vendor supplying it should be treated with suspicion.
• Which reviewer model to choose. In-house nurse consultant, retained external reviewer, or a records-review vendor — the right answer depends on volume, cost per review and turnaround, and it changes as a firm scales. The capacity planner models the arithmetic of each; the choice is the firm’s.
• Anything specific to your jurisdiction. Certificate-of-merit requirements, expert affidavit rules and limitation periods all bear directly on screening and all vary. Where we publish those, they will be cited statute by statute — see the malpractice climate page, which is currently incomplete and says so.

When a named clinical reviewer is retained, this manual is rewritten under their name and this section shrinks. The reviewer bench is published here, including the part that is not yet in place.