Revenue Recognition Revenue Recognition

3 Months Ended

Mar. 31, 2023

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Revenue Recognition [Text Block]

Revenue recognition

The following tables summarize the Company's segment revenues by primary payor source:

	Three months ended March 31, 2023						Three months ended March 31, 2022
	U.S. dialysis		Other — Ancillary services		Consolidated		U.S. dialysis		Other — Ancillary services		Consolidated
Dialysis patient service revenues:
Medicare and Medicare Advantage	$	1,482,767	$		$	1,482,767	$	1,464,086	$		$	1,464,086
Medicaid and Managed Medicaid	205,776				205,776		189,655				189,655
Other government	82,044		121,585		203,629		80,800		116,895		197,695
Commercial	835,393		54,516		889,909		834,579		52,425		887,004
Other revenues:
Medicare and Medicare Advantage			93,238		93,238				83,596		83,596
Medicaid and Managed Medicaid			570		570				538		538
Commercial			1,206		1,206				1,338		1,338
Other(1)	6,180		12,839		19,019		5,976		9,836		15,812
Eliminations of intersegment revenues	(22,047)		(1,368)		(23,415)		(22,169)				(22,169)
Total	$	2,590,113	$	282,586	$	2,872,699	$	2,552,927	$	264,628	$	2,817,555

(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. integrated kidney care (IKC) and other ancillary services and international operations.

There are significant uncertainties 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 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 integrated kidney care (IKC) revenues include revenues earned under risk-based arrangements, 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 (the Company's counterparty), with adjustments where applicable, or on trended or adjusted medical cost targets.