Revenue Recognition Revenue Recognition

9 Months Ended

Sep. 30, 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 September 30, 2023						Three months ended September 30, 2022
	U.S. dialysis		Other — Ancillary services		Consolidated		U.S. dialysis		Other — Ancillary services		Consolidated
Dialysis patient service revenues:
Medicare and Medicare Advantage	$	1,515,860			$	1,515,860	$	1,535,680			$	1,535,680
Medicaid and Managed Medicaid	207,327				207,327		193,853				193,853
Other government	90,549		$	128,980	219,529		86,852		$	116,084	202,936
Commercial	965,331		68,192		1,033,523		880,812		56,170		936,982
Other revenues:
Medicare and Medicare Advantage			137,149		137,149				78,345		78,345
Medicaid and Managed Medicaid			331		331				412		412
Commercial			16,063		16,063				6,484		6,484
Other(1)	6,239		11,832		18,071		6,056		10,903		16,959
Eliminations of intersegment revenues	(24,289)		(2,232)		(26,521)		(22,957)		—		(22,957)
Total	$	2,761,017	$	360,315	$	3,121,332	$	2,680,296	$	268,398	$	2,948,694

(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.

	Nine months ended September 30, 2023						Nine months ended September 30, 2022
	U.S. dialysis		Other — Ancillary services		Consolidated		U.S. dialysis		Other — Ancillary services		Consolidated
Dialysis patient service revenues:
Medicare and Medicare Advantage	$	4,538,264			$	4,538,264	$	4,529,300			$	4,529,300
Medicaid and Managed Medicaid	629,118				629,118		570,380				570,380
Other government	265,119		$	376,530	641,649		253,731		$	349,633	603,364
Commercial	2,676,758		183,578		2,860,336		2,570,054		164,302		2,734,356
Other revenues:
Medicare and Medicare Advantage			317,624		317,624				255,204		255,204
Medicaid and Managed Medicaid			1,296		1,296				1,181		1,181
Commercial			20,888		20,888				16,029		16,029
Other(1)	18,822		38,108		56,930		18,124		29,584		47,708
Eliminations of intersegment revenues	(66,698)		(5,007)		(71,705)		(64,516)		—		(64,516)
Total	$	8,061,383	$	933,017	$	8,994,400	$	7,877,073	$	815,933	$	8,693,006

(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.     

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.