Revenue Recognition

12 Months Ended

Dec. 31, 2020

Text Block [Abstract]

Revenue from Contract with Customer

Revenue recognition and accounts receivable

The Company's revenues by segment and primary payor source were as follows:

	Year ended December 31, 2020
	U.S. dialysis		Other - Ancillary services		Consolidated
Patient service revenues:
Medicare and Medicare Advantage	$	6,048,043	$		$	6,048,043
Medicaid and Managed Medicaid	744,862				744,862
Other government	455,897		380,584		836,481
Commercial	3,370,562		170,394		3,540,956
Other revenues:
Medicare and Medicare Advantage			419,662		419,662
Medicaid and Managed Medicaid			1,227		1,227
Commercial			33,246		33,246
Other(1)	40,571		47,585		88,156
Eliminations of intersegment revenues	(145,286)		(16,743)		(162,029)
Total	$	10,514,649	$	1,035,955	$	11,550,604

(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, 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.

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

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, no additional revenue was recognized during the year ended December 31, 2020 associated with performance obligations satisfied prior to January 1, 2018 and additional revenue of $37,274 was recognized during the year ended December 31, 2019 associated with performance obligations satisfied in years prior to 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, 2020 or 2019. 

Net dialysis services accounts receivable and other receivables from Medicare, including Medicare Advantage plans, and Medicaid, including managed Medicaid plans, were approximately $1,101,837 and $1,038,248 as of December 31, 2020 and 2019, respectively. Approximately 17% and 18% of the Company’s net patient services accounts receivable balances as of December 31, 2020 and 2019, respectively, were more than six months old. There were no significant balances over one year old at December 31, 2020. The Company's accounts receivable are principally due from Medicare and Medicaid programs and commercial insurance plans.