Revenue Recognition Revenue Recognition

6 Months Ended

Jun. 30, 2019

Revenue recognition

The Company’s allowance for doubtful accounts related to performance obligations satisfied in years prior to January 1, 2018 was $29,022 and $52,924 as of June 30, 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, without limitation, determination of 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 $12,617 and $39,795 was recognized during the three and six months ended June 30, 2019, respectively, associated with performance obligations satisfied prior to January 1, 2019. Additional revenue of $8,817 and $76,227 was recognized during the three and six months ended June 30, 2018, respectively, associated with performance obligations satisfied prior to January 1, 2018, which included a benefit of $12,000 and $36,000 for those respective periods from electing to apply Topic 606, Revenue from Contracts with Customers 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
	June 30, 2019									June 30, 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	$	1,520,193		$			$	1,520,193		$	1,526,066		$			$	1,526,066
Medicaid and Managed Medicaid	160,242						160,242			150,288						150,288
Other government	110,565			88,770			199,335			110,338			86,530			196,868
Commercial	840,993			33,095			874,088			796,732			19,139			815,871
Other revenues:
Medicare and Medicare Advantage				64,012			64,012						154,028			154,028
Medicaid and Managed Medicaid				94			94						16,158			16,158
Commercial				32,307			32,307						17,006			17,006
Other⁽¹⁾	5,501			20,670			26,171			4,919			35,034			39,953
Eliminations of intersegment revenues	(30,334		)	(3,403		)	(33,737		)	(20,096		)	(9,189		)	(29,285		)
Total	$	2,607,160		$	235,545		$	2,842,705		$	2,568,247		$	318,706		$	2,886,953


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



	For the six months ended
	June 30, 2019									June 30, 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	$	3,013,709		$			$	3,013,709		$	3,011,258		$			$	3,011,258
Medicaid and Managed Medicaid	314,431						314,431			307,783						307,783
Other government	216,692			173,245			389,937			217,458			169,068			386,526
Commercial	1,629,407			66,483			1,695,890			1,579,711			38,857			1,618,568
Other revenues:
Medicare and Medicare Advantage				125,713			125,713						296,786			296,786
Medicaid and Managed Medicaid				100			100						31,949			31,949
Commercial				64,925			64,925						57,427			57,427
Other⁽¹⁾	10,406			38,420			48,826			10,033			73,973			84,006
Eliminations of intersegment revenues	(60,975		)	(6,739		)	(67,714		)	(38,519		)	(19,387		)	(57,906		)
Total	$	5,123,670		$	462,147		$	5,585,817		$	5,087,724		$	648,673		$	5,736,397


(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.