Revenue Recognition Revenue Recognition

9 Months Ended

Sep. 30, 2020

Text Block [Abstract]

Revenue Recognition [Text Block]

Revenue recognition

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

	Three months ended September 30, 2020									Three months ended September 30, 2019
	U.S. dialysis			Other - Ancillary services			Consolidated			U.S. dialysis			Other - Ancillary services			Consolidated
Dialysis patient service revenues:
Medicare and Medicare Advantage	$	1,510,982		$			$	1,510,982		$	1,558,890		$			$	1,558,890
Medicaid and Managed Medicaid	193,254						193,254			176,292						176,292
Other government	114,327			98,044			212,371			116,984			90,947			207,931
Commercial	858,247			43,845			902,092			828,953			37,276			866,229
Other revenues:
Medicare and Medicare Advantage				111,248			111,248						65,759			65,759
Medicaid and Managed Medicaid				412			412						227			227
Commercial				7,799			7,799						33,503			33,503
Other(1)	17,409			9,895			27,304			10,308			20,784			31,092
Eliminations of intersegment revenues	(37,317		)	(4,079		)	(41,396		)	(32,362		)	(3,483		)	(35,845		)
Total	$	2,656,902		$	267,164		$	2,924,066		$	2,659,065		$	245,013		$	2,904,078

(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.

	Nine months ended September 30, 2020									Nine months ended September 30, 2019
	U.S. dialysis			Other - Ancillary services			Consolidated			U.S. dialysis			Other - Ancillary services			Consolidated
Dialysis patient service revenues:
Medicare and Medicare Advantage	$	4,530,510		$			$	4,530,510		$	4,572,599		$			$	4,572,599
Medicaid and Managed Medicaid	547,045						547,045			490,723						490,723
Other government	342,996			283,431			626,427			333,675			264,191			597,866
Commercial	2,534,388			118,869			2,653,257			2,458,360			103,760			2,562,120
Other revenues:
Medicare and Medicare Advantage				309,555			309,555						191,472			191,472
Medicaid and Managed Medicaid				1,061			1,061						327			327
Commercial				27,370			27,370						98,428			98,428
Other(1)	30,846			36,600			67,446			20,715			59,204			79,919
Eliminations of intersegment revenues	(104,987		)	(12,402		)	(117,389		)	(93,337		)	(10,222		)	(103,559		)
Total	$	7,880,798		$	764,484		$	8,645,282		$	7,782,735		$	707,160		$	8,489,895

(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.

The Company had no allowance for doubtful accounts related to performance obligations satisfied in years prior to January 1, 2018 as of September 30, 2020 and had a balance of $8,328 as of December 31, 2019.

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 insurance 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.

Dialysis patient service revenues. Revenues are recognized based on the Company’s estimate of the transaction price the Company expects to collect as a result of satisfying its performance obligations. Dialysis patient service revenues are recognized in the period services are provided based on these estimates. Revenues consist primarily of payments from government and commercial health plans for dialysis 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 fees for management and administrative support services provided to outpatient dialysis businesses that the Company does not own or in which the Company owns a noncontrolling interest as well as revenues associated with the Company's non-dialysis ancillary services.