Revenue Recognition Revenue Recognition

3 Months Ended

Mar. 31, 2019

Revenue recognition

The Company’s allowance for doubtful accounts related to performance obligations satisfied in years prior was $42,235 and $52,924 as of March 31, 2019 and December 31, 2018, respectively.

There are significant uncertainties associated with estimating revenue, which generally take several years to resolve. These estimates are subject to ongoing insurance coverage changes, geographic coverage differences, differing interpretations of contract coverage and other payor issues, as well as patient issues including determining applicable primary and secondary coverage, changes in patient coverage and coordination of benefits. As these estimates are refined over time, both positive and negative adjustments to revenue are recognized in the current period. As a result of changes in these estimates, additional revenue of $27,179 was recognized during the three months ended March 31, 2019 associated with performance obligations satisfied prior to January 1, 2019. Additional revenue of $67,410 was recognized during the three months ended March 31, 2018 associated with performance obligations satisfied prior to January 1, 2018, which included $24,000 from electing to apply ASC Topic 606 only to contracts not substantially completed as of January 1, 2018.

The following table summarizes the Company's segment revenues by primary payor source:



	For the three months ended
	March 31, 2019									March 31, 2018
	U.S. dialysis and related lab services			Other - Ancillary services and strategic initiatives			Consolidated			U.S. dialysis and related lab services			Other - Ancillary services and strategic initiatives			Consolidated
Patient service revenues:
Medicare and Medicare Advantage	$	1,493,516		$	—		$	1,493,516		$	1,485,192		$	—		$	1,485,192
Medicaid and Managed Medicaid	154,190			—			154,190			157,496			—			157,496
Other government	106,127			84,475			190,602			107,119			82,537			189,656
Commercial	788,413			33,388			821,801			782,979			19,718			802,697
Other revenues:
Medicare and Medicare Advantage	—			61,700			61,700			—			142,758			142,758
Medicaid and Managed Medicaid	—			6			6			—			15,791			15,791
Commercial	—			32,619			32,619			—			40,420			40,420
Other⁽¹⁾	4,905			17,750			22,655			5,114			38,941			44,055
Eliminations of intersegment revenues	(30,641		)	(3,336		)	(33,977		)	(18,422		)	(10,199		)	(28,621		)
Total	$	2,516,510		$	226,602		$	2,743,112		$	2,519,478		$	329,966		$	2,849,444


(1)	Other consists of management fees and revenue from the Company's ancillary services and strategic initiatives.

Dialysis and related lab patient service revenues

Dialysis and related lab services patient service revenues are recognized in the period services are provided. Revenues consist primarily of payments from Medicare, Medicaid and commercial health plans for dialysis and related lab services provided to patients. A usual and customary fee schedule is maintained for the Company’s dialysis treatments and related lab services; however, actual collectible revenue is normally recognized at a discount from the fee schedule.

Other revenues

Other revenues consist of the revenues associated with the ancillary services and strategic initiatives, management and administrative support services that are provided to outpatient dialysis centers that the Company does not own or in which the Company owns a noncontrolling interest, and administrative and management support services to certain other non-dialysis joint ventures in which the Company owns a noncontrolling interest.