Revenue Recognition

12 Months Ended

Dec. 31, 2021

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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, 2021
	U.S. dialysis		Other - Ancillary services		Consolidated
Patient service revenues:
Medicare and Medicare Advantage	$	6,133,235	$		$	6,133,235
Medicaid and Managed Medicaid	782,430				782,430
Other government	328,256		463,385		791,641
Commercial	3,397,697		199,024		3,596,721
Other revenues:
Medicare and Medicare Advantage			326,696		326,696
Medicaid and Managed Medicaid			1,321		1,321
Commercial			15,553		15,553
Other(1)	25,345		40,945		66,290
Eliminations of intersegment revenues	(90,796)		(4,294)		(95,090)
Total	$	10,576,167	$	1,042,630	$	11,618,797

(1)Other consists of management service fees earned in the respective Company line of business as well as other non-patient service revenue from the Company's U.S. ancillary services and international operations.

	Year ended December 31, 2020
	U.S. dialysis		Other - Ancillary services		Consolidated
Patient service revenues:
Medicare and Medicare Advantage(1)	$	6,169,226	$		$	6,169,226
Medicaid and Managed Medicaid	744,862				744,862
Other government(1)	334,714		380,584		715,298
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(2)	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)During the first quarter of 2021, the Company realigned the classification of revenue previously disclosed in the "Other government" category to the "Medicare and Medicare Advantage" category for certain government-reimbursed plans which have structure and payment characteristics similar to traditional Medicare Advantage plans. The classification of revenue for these plans for the year ended December 31, 2020 has also been recast 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 non-patient service revenue from the Company's U.S. ancillary services and international operations.

	Year ended December 31, 2019
	U.S. dialysis		Other - Ancillary services		Consolidated
Patient service revenues:
Medicare and Medicare Advantage(1)	$	6,246,636	$		$	6,246,636
Medicaid and Managed Medicaid	669,089				669,089
Other government(1)	329,071		352,765		681,836
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(2)	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)During the first quarter of 2021, the Company realigned the classification of revenue previously disclosed in the "Other government" category to the "Medicare and Medicare Advantage" category for certain government-reimbursed plans which have structure and payment characteristics similar to traditional Medicare Advantage plans. The classification of revenue for these plans for the year ended December 31, 2019 has also been recast 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 non-patient revenue from the Company's U.S. ancillary services and international operations.

The majority of the Company's non-patient service revenues from Medicare and Medicare Advantage, Medicaid and Managed Medicaid, and commercial sources represent risk-based revenues earned by the Company's U.S. integrated care and disease management business.

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.

No single commercial payor accounted for more than 10% of total consolidated accounts receivable or consolidated revenues at or for the years ended December 31, 2021 or 2020. 

Dialysis services accounts receivable and other receivables from Medicare, including Medicare Advantage plans, and Medicaid, including managed Medicaid plans, were approximately $1,174,123 and $1,101,837 as of December 31, 2021 and 2020, respectively. Approximately 16% and 17% of the Company’s patient services accounts receivable balances as of December 31, 2021 and 2020, respectively, were more than six months old. There were no significant balances over one year old at December 31, 2021. The Company's accounts receivable are principally due from Medicare and Medicaid programs and commercial insurance plans.