Note C — Revenue Recognition

Patient Care Segment

Revenue in our Patient Care segment is primarily derived from contracts with third party payors for the provision of O&P devices and is recognized upon the transfer of control of promised products or services to the patient at the time the patient receives the device. At, or subsequent to delivery, we issue an invoice to the third party payor, which primarily consists of commercial insurance companies, Medicare, Medicaid, the VA, and Private Pay individuals. We recognize revenue for the amounts we expect to receive from payors based on expected contractual reimbursement rates, which are net of estimated contractual discounts and implicit price concessions. These revenue amounts are further revised as claims are adjudicated, which may result in additional disallowances.

The following table disaggregates revenue from contracts with customers in our Patient Care segment for the years ended December 31, 2019, 2018, and 2017:


	For the Years Ended December 31,
(in thousands)	2019		2018			2017
Patient Care Segment
Medicare	$	289,099	$	273,833	$	260,275
Medicaid		143,438		132,938		132,707
Commercial Insurance/Managed Care (excluding Medicare and Medicaid Managed Care)		323,499		316,243		325,639
Veterans Administration		89,035		78,328		74,435
Private Pay		60,620		56,040		58,917
Total	$	905,691	$	857,382	$	851,973

The impact to revenue related to prior period performance obligations was not material for the years ended December 31, 2019, 2018, and 2017.

Products & Services Segment

Revenue in our Products & Services segment is derived from the distribution of O&P components and from therapeutic solutions which includes the leasing and sale of rehabilitation equipment and ancillary consumable supplies combined with equipment maintenance, education, and training.

The following table disaggregates revenue from contracts with customers in our Product & Services segment for the years ended December 31, 2019, 2018, and 2017:


	For the Years Ended December 31,
(in thousands)	2019		2018			2017
Products & Services Segment
Distribution services, net of intersegment revenue eliminations	$	143,400	$	135,995	$	128,686
Therapeutic solutions		48,955		55,383		60,110
Total	$	192,355	$	191,378	$	188,796