Revenue Recognition Revenue Recognition

3 Months Ended

Mar. 31, 2022

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Revenue Recognition [Text Block]

Revenue recognition

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

	Three months ended March 31, 2022						Three months ended March 31, 2021
	U.S. dialysis		Other — Ancillary services		Consolidated		U.S. dialysis		Other — Ancillary services		Consolidated
Dialysis patient service revenues:
Medicare and Medicare Advantage	$	1,464,086	$		$	1,464,086	$	1,480,297	$		$	1,480,297
Medicaid and Managed Medicaid	189,655				189,655		187,243				187,243
Other government	80,800		116,895		197,695		80,184		106,830		187,014
Commercial	834,579		52,425		887,004		835,479		51,498		886,977
Other revenues:
Medicare and Medicare Advantage			83,596		83,596				85,595		85,595
Medicaid and Managed Medicaid			538		538				300		300
Commercial			1,338		1,338				6,034		6,034
Other(1)	5,976		9,836		15,812		6,675		11,162		17,837
Eliminations of intersegment revenues	(22,169)				(22,169)		(27,003)		(4,293)		(31,296)
Total	$	2,552,927	$	264,628	$	2,817,555	$	2,562,875	$	257,126	$	2,820,001

(1)Other primarily 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.

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 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. The Company maintains a usual and customary fee schedule for its 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 revenues earned by the Company's non-dialysis ancillary services as well as fees for management and administrative services to outpatient dialysis businesses that the Company does not consolidate. Other revenues are estimated in the period services are provided. The Company's U.S. ancillary service revenues include revenues earned under risk-based arrangements in the Company's integrated kidney care (IKC) business, including value-based care (VBC) arrangements. Under its VBC arrangements, the Company assumes full or shared financial risk for the total medical cost of care for patients below or above a benchmark. The benchmarks against which the Company incurs profit or loss on these contracts are typically based on the underlying premiums paid to the insuring entity (our counterparty), with adjustments where applicable, or on trended or adjusted medical cost targets.