In 2003 I reported how my respiratory care department at Tufts-New England Medical Center developed an inexpensive, in-house, computerized clinical-information-management system, in which the respiratory therapists carry handheld computers during their rounds, entering clinical information into the handhelds as they work and later downloading that information to a database in a desktop computer. Now we have added a billing module to our customized software. This article describes the design, use, and attributes of this billing system, including improved charge-capture, which increased department revenue substantially. Our system has several other important advantages over traditional billing systems.