Revenue Recognition Revenue Recognition

9 Months Ended

Sep. 30, 2019

Revenue recognition

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, a reduction in revenue of $4,138 was recognized during the three months ended September 30, 2019 and additional revenue of $35,658 was recognized during the nine months ended September 30, 2019, associated with performance obligations satisfied prior to January 1, 2019. Additional revenue of $1,246 and $77,473 was recognized during the three and nine months ended September 30, 2018, respectively, associated with performance obligations satisfied prior to January 1, 2018, which included a benefit of $36,000 for the nine months ended September 30, 2018 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
	September 30, 2019									September 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	$	1,558,890		$			$	1,558,890		$	1,513,191		$			$	1,513,191
Medicaid and Managed Medicaid	176,292						176,292			159,165						159,165
Other government	116,984			90,947			207,931			113,043			80,915			193,958
Commercial	828,953			37,276			866,229			786,470			31,364			817,834
Other revenues:
Medicare and Medicare Advantage				65,759			65,759						130,746			130,746
Medicaid and Managed Medicaid				227			227						12,042			12,042
Commercial				33,503			33,503						20,205			20,205
Other⁽¹⁾	10,308			20,784			31,092			4,932			29,042			33,974
Eliminations of intersegment revenues	(32,362		)	(3,483		)	(35,845		)	(25,424		)	(8,361		)	(33,785		)
Total	$	2,659,065		$	245,013		$	2,904,078		$	2,551,377		$	295,953		$	2,847,330


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



	For the nine months ended
	September 30, 2019									September 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	$	4,572,599		$			$	4,572,599		$	4,524,449		$			$	4,524,449
Medicaid and Managed Medicaid	490,723						490,723			466,948						466,948
Other government	333,675			264,191			597,866			330,500			250,048			580,548
Commercial	2,458,360			103,760			2,562,120			2,366,182			70,156			2,436,338
Other revenues:
Medicare and Medicare Advantage				191,472			191,472						427,532			427,532
Medicaid and Managed Medicaid				327			327						43,991			43,991
Commercial				98,428			98,428						77,633			77,633
Other⁽¹⁾	20,715			59,204			79,919			14,965			103,014			117,979
Eliminations of intersegment revenues	(93,337		)	(10,222		)	(103,559		)	(63,943		)	(27,748		)	(91,691		)
Total	$	7,782,735		$	707,160		$	8,489,895		$	7,639,101		$	944,626		$	8,583,727


(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.

The Company’s allowance for doubtful accounts related to performance obligations satisfied in years prior to January 1, 2018 was $15,090 and $52,924 as of September 30, 2019 and December 31, 2018, respectively.