Revenue Recognition

12 Months Ended

Dec. 31, 2019

Revenue recognition and accounts receivable

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



	Year ended December 31, 2019
	U.S. dialysis			Other - Ancillary services			Consolidated
Patient service revenues:
Medicare and Medicare Advantage	$	6,129,697		$			$	6,129,697
Medicaid and Managed Medicaid	669,089						669,089
Other government	446,010			352,765			798,775
Commercial	3,286,089			144,256			3,430,345
Other revenues:
Medicare and Medicare Advantage				264,538			264,538
Medicaid and Managed Medicaid				606			606
Commercial				130,823			130,823
Other⁽¹⁾	32,021			78,940			110,961
Eliminations of intersegment revenues	(132,325		)	(14,030		)	(146,355		)
Total	$	10,430,581		$	957,898		$	11,388,479


(1)	Other consists of management service fees earned in the respective Company line of business as well as other revenue from the Company's ancillary services.



	Year ended December 31, 2018
	U.S. dialysis			Other - Ancillary services			Consolidated
Patient service revenues:
Medicare and Medicare Advantage	$	6,063,891		$			$	6,063,891
Medicaid and Managed Medicaid	628,766						628,766
Other government	446,999			335,594			782,593
Commercial	3,176,413			101,681			3,278,094
Other revenues:
Medicare and Medicare Advantage				492,812			492,812
Medicaid and Managed Medicaid				44,246			44,246
Commercial				90,890			90,890
Other⁽¹⁾	19,880			130,865			150,745
Eliminations of intersegment revenues	(92,950		)	(34,236		)	(127,186		)
Total	$	10,242,999		$	1,161,852		$	11,404,851


(1)	Other consists of management service fees earned in the respective Company line of business as well as other revenue from the Company's ancillary services.



	Year ended December 31, 2017⁽¹⁾
	U.S. dialysis			Other - Ancillary services			Consolidated
Patient service revenues:
Medicare and Medicare Advantage	$	5,253,012		$			$	5,253,012
Medicaid and Managed Medicaid	606,827						606,827
Other government	362,567			259,651			622,218
Commercial	3,117,920			63,505			3,181,425
Other revenues:
Medicare and Medicare Advantage				902,289			902,289
Medicaid and Managed Medicaid				71,426			71,426
Commercial				116,503			116,503
Other⁽²⁾	19,739			182,974			202,713
Eliminations of intersegment revenues	(55,176		)	(24,603		)	(79,779		)
Total	$	9,304,889		$	1,571,745		$	10,876,634


(1)	As noted above, prior period amounts have not been adjusted under the cumulative effect method. In this table, the Company's U.S. dialysis revenues for the year ended December 31, 2017 has been presented net of the provision for uncollectible accounts of $485,364 to conform to the current period presentation.


(2)	Other consists of management service fees earned in the respective Company line of business as well as other revenue from the Company's ancillary services.

The Company’s allowance for doubtful accounts related to performance obligations satisfied prior to the adoption of Topic 606 was $8,328 and $52,924 as of December 31, 2019 and 2018, respectively.

As described in Note 1, there are significant risks associated with estimating revenue, many of which 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 these changes in estimates, additional revenue of $37,274 was recognized during the year ended December 31, 2019 associated with performance obligations satisfied prior to January 1, 2019 and additional revenue of $88,495 was recognized during the year ended December 31, 2018 associated with performance obligations satisfied in years prior to the adoption of Topic 606, which

included a benefit of $36,000 from electing to apply Topic 606 only to contracts not substantially completed as of January 1, 2018.

There is no single commercial payor that accounted for more than 10% of total consolidated accounts receivable or consolidated revenues at or for the years ended December 31, 2019 or 2018.

Net dialysis services accounts receivable and other receivables from Medicare, including Medicare-assigned plans, and Medicaid, including managed Medicaid plans, were approximately $1,038,248 and $1,080,561 as of December 31, 2019 and 2018, respectively. Approximately 18% of the Company’s net patient services accounts receivable balances as of both December 31, 2019 and 2018, were more than six months old. There were no significant balances over one year old at December 31, 2019. The Company's accounts receivable are principally due from Medicare and Medicaid programs and commercial insurance plans.