Save $50,000 and boost morale with ED billers’

Overworked ED nurses at McKay-Dee Hospital Center in Ogden, UT, were frustrated with spending hours looking through charts to figure out charges for procedures.

Charging was the nurse’s lowest priority and often got left to the last of the shift or forgotten, says Kayleen L. Paul, RN, BS, CEN, care center director of emergency, critical care, and trauma services. "As our census got higher, it became glaringly apparent that we were missing charges," Paul says. "We were losing thousands of dollars because it was a priority for no one."

Experienced ED clerks now are used as billers, and they determine charges by reviewing the previous day’s charts, nurses notes, and physician dictation. They are extremely thorough and accurate, says Paul. "When we first began, I thought I could save enough money to recoup the billers’ salaries and be budget neutral: about $25,000 a year," she says. "We wound up increasing billing revenue by almost $50,000 that first year."

In addition, the billers bring examples of good and bad charting to critique at ED nursing staff meetings. "This input, both favorable and unfavorable, goes into nursing performance evaluations as appropriate," says Paul. "This has dramatically improved documentation." For example, nurses learned that they could charge time increments for intravenous (IV) fluid administration. "Nurses always charted a start time for IVs, but almost never charted a stop time, so we couldn’t charge accurately," she says.

The billers advised the nurses exactly what needed to be charted, and the group decided where it would be most conveniently charted in the nursing notes. "Our stop time charting has drastically improved," Paul notes.

[Editor’s note: For more information on ED billers, contact Kayleen L. Paul, RN, BS, CEN, Care Center Director, Emergency, Critical Care, and Trauma Services, McKay-Dee Hospital Center, 4401 Harrison Blvd., Ogden, UT 84403. Telephone: (801) 387-7006. Fax: (801) 387-7038. E-mail:]