Why are Medicare and Medicaid shown separately instead of combined?

They come from two different CMS data sources with no shared claim identifier, so they can't be reconciled into one number without double-counting or guessing. Every table and chart on this page keeps them fully separate.

Why is there no private/commercial revenue figure?

Private and commercial payer data comes from Transparency in Coverage files, which only publish negotiated rates — not claims or utilization volume. Without a volume figure, no revenue number can be computed for any provider from that data.

What does "Rank" mean in the Competitive Analysis & Benchmarks tables?

For a given CPT/HCPCS code, it's this provider's position by claims volume among all providers billing that same code at that geography level (State, National, or North Carolina for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to North Carolina only?

Medicaid is administered per-state with no single national fee schedule, so a state or national comparison the way Medicare has one isn't available. North Carolina (this provider's own state) is the only grouping that's conceptually meaningful.

Why are the numbers rounded to the nearest 10?

To avoid implying more precision than the underlying data supports at a single-provider level. Ratios are kept precise since they're a relative comparison, not a volume or dollar figure.

How current is this data?

The Medicare and Medicaid tables are both single current snapshots, not refreshed on a recurring schedule yet.

Forsyth Memorial Hospital, Inc. (NPI 1447200233)

Key Findings

Field	Value
Entity Type	Organization
Organization	Forsyth Memorial Hospital, Inc.
Address	3333 Silas Creek Pkwy
City	Winston Salem
State	NC
ZIP	27103
Taxonomy	General Acute Care Hospital
NPI Enumerated	May 11, 2006

Payer Source	Total Paid
Medicaid	$40.9M
Medicare	$0

This provider has no Medicare billing on file and is effectively a Medicaid-focused hospital: total Medicaid revenue is $40.9M and there is no Medicare revenue reported. The absence of Medicare billing indicates the facility’s payer exposure is highly concentrated on Medicaid payers rather than a mixed Medicare/Medicaid case mix.

Medicaid revenue is highly concentrated in emergency department evaluation-and-management services: the precomputed top-3 Medicaid codes account for 62.9% of this provider’s total Medicaid revenue, led by 99284 ($12.6M, 32.4%), 99283 ($7M, 18.0%), and 99285 ($4.8M, 12.4%). This concentration implies that Medicaid ED visits are the primary revenue driver and a small set of E/M codes dominate financial performance.

The code mix and claim volumes point to a high-throughput emergency care operation supported by on-site diagnostics and IV therapy. High-volume ED codes (99284: 67.9K claims; 99283: 69.9K claims; 99285: 21.5K claims) combine with large counts of IV administration codes (96374: 31.9K claims, 96375: 20K claims, 96361: 18.4K claims) and imaging/lab activity (74177, 70450, 85025, 80053), consistent with an acute-care hospital that manages many emergent presentations and provides immediate diagnostics and infusion therapy.

Competitive standing within the state Medicaid market is strong for many ED-related services but not uniformly dominant across all acuity levels. For example, 99283 ranks #19 of 316 providers in-state (94th percentile; notably above typical state volume) while 99284 ranks #22 of 325 (94th percentile; typical, unremarkable volume) and 99285 ranks #44 of 281 (85th percentile; typical, unremarkable volume), indicating the hospital is a major Medicaid ED provider in NC, particularly at lower-to-moderate acuity levels.

Several service lines show extreme or unusually high utilization relative to in-state peers, suggesting operational patterns tied to high ED throughput. J3490 (239.6K claims) ranks #2 of 158 providers in-state (99th percentile; extreme outlier), J7030 (31.4K claims) ranks #2 of 89 (99th percentile; extreme outlier), and 81025 (18.6K claims) ranks #11 of 574 (98th percentile; extreme outlier), pointing to very large volumes of unclassified drug billing, saline infusions, and pregnancy testing compared with other North Carolina Medicaid providers.

Ancillary diagnostics and imaging contribute meaningful secondary revenue consistent with acute care capacity: CT abdomen/pelvis 74177 generates $1.9M (4.8% of Medicaid revenue) and CT head 70450 generates $1.1M (2.9%), while common lab panels like 85025 ($822.7K) and 80053 ($818.1K) also appear near the top of the ledger. These line items reinforce that the hospital provides on-site imaging and laboratory services that support ED and urgent inpatient workflows.

From a payer-management perspective, the provider’s heavy reliance on a small set of ED E/M codes and associated low-dollar, high-volume ancillary codes suggests revenue exposure to changes in ED utilization patterns and reimbursement for high-volume services. Because the top three codes drive the majority of Medicaid revenue (62.9%), interventions that affect ED visit volume, acuity coding, or reimbursement rates for those services could have a disproportionate impact on the facility’s Medicaid revenue.

The provider has an established NPI tenure (enumerated 2006-05-11, ~20 years ago), indicating a long-standing presence in the market; combined with $40.9M in Medicaid revenue and high percentile ranks on many acute-care codes, this supports a profile of a mature, high-throughput hospital that is a significant Medicaid ED provider in North Carolina.

Medicaid: Complete Services Breakdown

Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.

182 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
99284	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making.	67,890	$190	$12.6M
99283	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a low level of medical decision making.	69,870	$100	$7M
99285	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a high level of medical decision making.	21,510	$220	$4.8M
0241U	N/A	14,360	$140	$2M
74177	The provider performs computed tomography of the abdomen and pelvis with contrast material to diagnose the cause of abdominal or pelvic pain or other abnormalities of the internal organs.	3,410	$550	$1.9M
70450	The provider performed computed tomography, or CT scanning, of the head or brain, without contrast. He performs the procedure to diagnose any brain or intracranial abnormalities.	8,870	$130	$1.1M
96375	Following the administration of a drug or other substance via intravenous, or IV, push, the provider sequentially infuses a different medication or medications, also via IV push. He administers the…	19,990	$50	$1.1M
96374	The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition.	31,920	$30	$989.5K
93005	The provider records the electrical conduction of the heart to examine any abnormality in its functioning, based on signals from at least 12 leads, wires that connect the recording device to…	38,150	$20	$915.6K
85025	A complete blood count (better known as a CBC) is a blood test request by a doctor that provides detailed information about various types of cells in a patient's blood. Usually a pathologist or a…	117,530	$10	$822.7K

Showing 1–10 of 182

Medicaid: Competitive Analysis & Benchmarks

How this provider's Medicaid billing volume and revenue compare to other North Carolina providers billing the same CPT/HCPCS codes.

Claims Volume vs. North Carolina Distribution

Forsyth Memorial Hospital, Inc. — 12 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — North Carolina

Full comparison — all codes billed, vs. North Carolina median

182 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
99284	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making.	22	330	6,130	$130	$2.7M
U0003	Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high…	141	160	840	$70	$2.3M
99283	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a low level of medical decision making.	19	320	6,160	$120	$2.1M
99285	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a high level of medical decision making.	44	280	2,690	$130	$1.6M
87798	The lab analyst performs a test for an infectious agent not specified in another code using an amplified nucleic acid probe technique. Use this code if you know the laboratory technique is amplified…	72	80	420	$30	$1.2M
80307	The lab analyst performs presumptive drug test(s) via instrumented chemistry analyzers to screen for any number of drug classes on a single date.	80	360	1,830	$40	$819.8K
97530	The provider uses various activities during direct contact with the patient to improve the patient’s functional performance. Use this code for each 15 minutes of activity.	505	520	2,870	$70	$721.7K
G0463	Hospital outpatient clinic visit for assessment and management of a patient	9	90	4,210	$30	$676.8K
87491	The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique.	157	190	530	$20	$635.1K
H0015	Alcohol and/or drug services; intensive outpatient (treatment program that operates at least 3 hours/day and at least 3 days/week and is based on an individualized treatment plan), including…	57	110	1,070	$130	$628.2K

Showing 1–10 of 182

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Novant Health Medical Group LLC	NC	Pediatrics Physician	$0	$20.4M
Novant Health Medical Group, LLC	NC	Internal Medicine Physician	$0	$15.3M
Brunswick Community Hospital, LLC	NC	General Acute Care Hospital	$0	$15M
Novant Health Medical Group, LLC	NC	Pediatrics Physician	$0	$8.6M
Gregory Borstad	NC	Rheumatology Physician	$1.6M	$0
Karrie Grear	NC	Neurology Physician	$1.5M	$0
Mayur Patel	NC	Rheumatology Physician	$1M	$0
David Eagle	NY	Hematology & Oncology Physician	$803.3K	$23.7K
Christopher Snyder	NC	Dermatology Physician	$753.6K	$0
Nasfat Shehadeh	NC	Hematology & Oncology Physician	$700K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Bayada Home Health Care, Inc.	NC	Home Health Agency	$0	$39.5M
Bayada Home Health Care, Inc.	NC	Developmental Disabilities Clinic/Center	$0	$35.4M
Bayada Home Health Care, Inc.	NC	Home Health Agency	$0	$34.4M
Rafael Rivera, Jr., Dds, PLLC	NC	Dentist	$0	$22.1M
Bayada Home Health Care, Inc.	NC	Home Health Agency	$0	$21M
A Bridge To Achievement Nc, LLC	NC	Community/Behavioral Health Agency	$0	$15.6M
Nevaeh & Company LLC	NC	Customized Equipment (DME)	$0	$12.1M
Speechcenter LLC, D/b/a Sidekick Therapy Partners	NC	Speech-Language Pathologist	$0	$10.8M
Champion Family Healthcare Services, LLC	NC	Home Health Agency	$0	$9.9M
Winston-salem Forysth County Schools	NC	Local Education Agency (LEA)	$0	$9.1M

Forsyth Memorial Hospital, Inc. — Billing Profile & Reimbursement Data

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Forsyth Memorial Hospital, Inc. — Billing Profile & Reimbursement Data

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Key Findings

Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Related Providers

Nearby Providers

Frequently Asked Questions

References