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Revenue | 9 Months Ended
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Sep. 30, 2021
Revenue From Contract With Customer [Abstract] |
Revenue | (12) Revenue The company recognizes revenue when it transfers promised goods or services to customers in an amount that reflects the consideration to which the company expects to be entitled in exchange for those goods or services. Our estimate for amounts not expected to be collected based on historical experience will continue to be recognized as a reduction to net revenue. However, subsequent changes in estimate of collectability due to a change in the financial status of a payer, for example a bankruptcy, will be recognized as bad debt expense in operating charges. The performance obligation is separately identifiable from other promises in the customer contract. As the performance obligations are met (i.e.: room, board, ancillary services, level of care), revenue is recognized based upon allocated transaction price. The transaction price is allocated to separate performance obligations based upon the relative standalone selling price. In instances where we determine there are multiple performance obligations across multiple months, the transaction price will be allocated by applying an estimated implicit and explicit rate to gross charges based on the separate performance obligations. In assessing collectability, we have elected the portfolio approach. This portfolio approach is being used as we have large volume of similar contracts with similar classes of customers. We reasonably expect that the effect of applying a portfolio approach to a group of contracts would not differ materially from considering each contract separately. Management’s judgment to group the contracts by portfolio is based on the payment behavior expected in each portfolio category. As a result, aggregating all of the contracts (which are at the patient level) by the particular payer or group of payers, will result in the recognition of the same amount of revenue as applying the analysis at the individual patient level. We group our revenues into categories based on payment behaviors. Each component has its own reimbursement structure which allows us to disaggregate the revenue into categories that share the nature and timing of payments. The other patient revenue consists primarily of self-pay, government-funded non-Medicaid, and other. The following table disaggregates our revenue by major source for the three and nine-month periods ended September 30, 2021 and 2020 (in thousands):
| For the three months ended September 30, 2021 |
| Acute Care |  |  | Behavioral Health |  |  | Other |  |  | Total |
Medicare | $ | 310,483 |  |  | 17 | % |  | $ | 96,219 |  |  | 7 | % |  |  |  |  |  | $ | 406,702 |  |  | 13 | %
Managed Medicare |  | 280,674 |  |  | 15 | % |  |  | 66,249 |  |  | 5 | % |  |  |  |  |  |  | 346,923 |  |  | 11 | %
Medicaid |  | 136,989 |  |  | 8 | % |  |  | 146,281 |  |  | 11 | % |  |  |  |  |  |  | 283,270 |  |  | 9 | %
Managed Medicaid |  | 176,497 |  |  | 10 | % |  |  | 326,789 |  |  | 25 | % |  |  |  |  |  |  | 503,286 |  |  | 16 | %
Managed Care (HMO and PPOs) |  | 674,396 |  |  | 37 | % |  |  | 349,275 |  |  | 26 | % |  |  |  |  |  |  | 1,023,671 |  |  | 32 | %
UK Revenue |  | 0 |  |  | 0 | % |  |  | 173,728 |  |  | 13 | % |  |  |  |  |  |  | 173,728 |  |  | 6 | %
Other patient revenue and adjustments, net |  | 69,935 |  |  | 4 | % |  |  | 117,442 |  |  | 9 | % |  |  |  |  |  |  | 187,377 |  |  | 6 | %
Other non-patient revenue (a) |  | 173,053 |  |  | 9 | % |  |  | 52,310 |  |  | 4 | % |  |  | 5,679 |  |  |  | 231,042 |  |  | 7 | %
Total Net Revenue | $ | 1,822,027 |  |  | 100 | % |  | $ | 1,328,293 |  |  | 100 | % |  | $ | 5,679 |  |  |  | 3,155,999 |  |  | 100 | %
| For the nine months ended September 30, 2021 |
| Acute Care |  |  | Behavioral Health |  |  | Other |  |  | Total |
Medicare | $ | 954,207 |  |  | 18 | % |  | $ | 277,438 |  |  | 7 | % |  |  |  |  |  | $ | 1,231,645 |  |  | 13 | %
Managed Medicare |  | 830,627 |  |  | 16 | % |  |  | 185,323 |  |  | 5 | % |  |  |  |  |  |  | 1,015,950 |  |  | 11 | %
Medicaid |  | 418,335 |  |  | 8 | % |  |  | 526,945 |  |  | 13 | % |  |  |  |  |  |  | 945,280 |  |  | 10 | %
Managed Medicaid |  | 473,256 |  |  | 9 | % |  |  | 995,749 |  |  | 24 | % |  |  |  |  |  |  | 1,469,005 |  |  | 16 | %
Managed Care (HMO and PPOs) |  | 1,862,012 |  |  | 35 | % |  |  | 1,070,165 |  |  | 26 | % |  |  |  |  |  |  | 2,932,177 |  |  | 31 | %
UK Revenue |  | 0 |  |  | 0 | % |  |  | 510,614 |  |  | 13 | % |  |  |  |  |  |  | 510,614 |  |  | 5 | %
Other patient revenue and adjustments, net |  | 248,342 |  |  | 5 | % |  |  | 366,669 |  |  | 9 | % |  |  |  |  |  |  | 615,011 |  |  | 7 | %
Other non-patient revenue (a) |  | 484,221 |  |  | 9 | % |  |  | 142,224 |  |  | 3 | % |  |  | 20,739 |  |  |  | 647,184 |  |  | 7 | %
Total Net Revenue | $ | 5,271,000 |  |  | 100 | % |  | $ | 4,075,127 |  |  | 100 | % |  | $ | 20,739 |  |  | $ | 9,366,866 |  |  | 100 | %
| For the three months ended September 30, 2020 |
| Acute Care |  |  | Behavioral Health |  |  | Other |  |  | Total |
Medicare | $ | 319,259 |  |  | 20 | % |  | $ | 120,691 |  |  | 9 | % |  |  |  |  |  | $ | 439,950 |  |  | 15 | %
Managed Medicare |  | 234,169 |  |  | 15 | % |  |  | 62,618 |  |  | 5 | % |  |  |  |  |  |  | 296,787 |  |  | 10 | %
Medicaid |  | 160,671 |  |  | 10 | % |  |  | 159,756 |  |  | 12 | % |  |  |  |  |  |  | 320,427 |  |  | 11 | %
Managed Medicaid |  | 126,979 |  |  | 8 | % |  |  | 316,683 |  |  | 24 | % |  |  |  |  |  |  | 443,662 |  |  | 15 | %
Managed Care (HMO and PPOs) |  | 585,333 |  |  | 36 | % |  |  | 321,719 |  |  | 25 | % |  |  |  |  |  |  | 907,052 |  |  | 31 | %
UK Revenue |  | 0 |  |  | 0 | % |  |  | 155,323 |  |  | 12 | % |  |  |  |  |  |  | 155,323 |  |  | 5 | %
Other patient revenue and adjustments, net |  | 56,188 |  |  | 3 | % |  |  | 127,322 |  |  | 10 | % |  |  |  |  |  |  | 183,510 |  |  | 6 | %
Other non-patient revenue (b) |  | 127,404 |  |  | 8 | % |  |  | 35,479 |  |  | 3 | % |  |  | 2,947 |  |  |  | 165,830 |  |  | 6 | %
Total Net Revenue | $ | 1,610,003 |  |  | 100 | % |  | $ | 1,299,591 |  |  | 100 | % |  | $ | 2,947 |  |  | $ | 2,912,541 |  |  | 100 | %
| For the nine months ended September 30, 2020 |
| Acute Care |  |  | Behavioral Health |  |  | Other |  |  | Total |
Medicare | $ | 909,594 |  |  | 20 | % |  | $ | 346,879 |  |  | 9 | % |  |  |  |  |  | $ | 1,256,473 |  |  | 15 | %
Managed Medicare |  | 638,931 |  |  | 14 | % |  |  | 181,835 |  |  | 5 | % |  |  |  |  |  |  | 820,766 |  |  | 10 | %
Medicaid |  | 420,082 |  |  | 9 | % |  |  | 488,864 |  |  | 13 | % |  |  |  |  |  |  | 908,946 |  |  | 11 | %
Managed Medicaid |  | 358,770 |  |  | 8 | % |  |  | 900,105 |  |  | 23 | % |  |  |  |  |  |  | 1,258,875 |  |  | 15 | %
Managed Care (HMO and PPOs) |  | 1,558,765 |  |  | 34 | % |  |  | 955,530 |  |  | 25 | % |  |  |  |  |  |  | 2,514,295 |  |  | 30 | %
UK Revenue |  | 0 |  |  | 0 | % |  |  | 428,795 |  |  | 11 | % |  |  |  |  |  |  | 428,795 |  |  | 5 | %
Other patient revenue and adjustments, net |  | 198,983 |  |  | 4 | % |  |  | 371,517 |  |  | 10 | % |  |  |  |  |  |  | 570,500 |  |  | 7 | %
Other non-patient revenue (b) |  | 513,433 |  |  | 11 | % |  |  | 191,298 |  |  | 5 | % |  |  | 8,581 |  |  |  | 713,312 |  |  | 8 | %
Total Net Revenue | $ | 4,598,558 |  |  | 100 | % |  | $ | 3,864,823 |  |  | 100 | % |  | $ | 8,581 |  |  | $ | 8,471,962 |  |  | 100 | %
(a) Acute Care includes CARES Act and other grant revenue of $2 million and $13 million recorded in the three and nine-months periods ended September 30, 2021, respectively. Behavioral Health includes CARES Act and other grant revenue of $114,000 and $2 million recorded in the three and nine-months periods ended September 30, 2021, respectively. (b) Acute Care includes CARES Act and other grant income of $4 million and $161 million recorded in the three and nine-months periods ended September 30, 2020, respectively. Behavioral Health includes the reversal of CARES Act and other grant income of $9 million and CARES Act and other grant income of $52 million recorded in the three and nine-months periods ended September 30, 2020, respectively As an accounting policy election, we have utilized ASC 958 by analogy to recognize funds received under the CARES Act from the Provider Relief Fund as revenue, given no direct authoritative guidance available to for-profit organizations to recognize revenue for government contributions and grants. CARES Act revenues may be subject to future adjustments based on future changes to statutes.

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- Definition The entire disclosure of revenue from contract with customer to transfer good or service and to transfer nonfinancial asset. Includes, but is not limited to, disaggregation of revenue, credit loss recognized from contract with customer, judgment and change in judgment related to contract with customer, and asset recognized from cost incurred to obtain or fulfill contract with customer. Excludes insurance and lease contracts. + References Reference 1: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 606 -URI http://asc.fasb.org/topic&trid=49130388 Reference 2: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 606 -SubTopic 10 -Section 50 -Paragraph 10 -URI http://asc.fasb.org/extlink&oid=123351226&loc=SL49130551-203045 Reference 3: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 606 -SubTopic 10 -Section 50 -Paragraph 13 -Subparagraph (b)(2) -URI http://asc.fasb.org/extlink&oid=123351226&loc=SL49130556-203045 Reference 4: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 606 -SubTopic 10 -Section 50 -Paragraph 12 -Subparagraph (b) -URI http://asc.fasb.org/extlink&oid=123351226&loc=SL49130554-203045 Reference 5: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 606 -SubTopic 10 -Section 50 -Paragraph 9 -URI http://asc.fasb.org/extlink&oid=123351226&loc=SL49130550-203045 Reference 6: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 606 -SubTopic 10 -Section 50 -Paragraph 12 -Subparagraph (e) -URI http://asc.fasb.org/extlink&oid=123351226&loc=SL49130554-203045 Reference 7: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 606 -SubTopic 10 -Section 50 -Paragraph 12 -Subparagraph (a) -URI http://asc.fasb.org/extlink&oid=123351226&loc=SL49130554-203045 Reference 8: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 606 -SubTopic 10 -Section 50 -Paragraph 12 -Subparagraph (d) -URI http://asc.fasb.org/extlink&oid=123351226&loc=SL49130554-203045 Reference 9: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 606 -SubTopic 10 -Section 50 -Paragraph 15 -URI http://asc.fasb.org/extlink&oid=123351226&loc=SL49130558-203045 Reference 10: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 606 -SubTopic 10 -Section 50 -Paragraph 12 -Subparagraph (c) -URI http://asc.fasb.org/extlink&oid=123351226&loc=SL49130554-203045 + Details
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