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Revenue Recognition | 12 Months Ended
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Dec. 31, 2018
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Revenue Recognition [Text Block] | Revenue recognition and accounts receivable The following table summarizes the Company's segment revenues by primary payor source:
| Year ended December 31, 2018
| U.S. dialysis and related lab services |  | Other - Ancillary services and strategic initiatives |  | Consolidated
Patient service revenues: |  |  |  |  |
Medicare and Medicare Advantage | $ | 6,063,891 |  |  | $ | — |  |  | $ | 6,063,891 |
Medicaid and Managed Medicaid | 628,766 |  |  | — |  |  | 628,766 |
Other government | 446,999 |  |  | 335,594 |  |  | 782,593 |
Commercial | 3,176,413 |  |  | 101,681 |  |  | 3,278,094 |
Other revenues: |  |  |  |  |
Medicare and Medicare Advantage | — |  |  | 492,812 |  |  | 492,812 |
Medicaid and Managed Medicaid | — |  |  | 44,246 |  |  | 44,246 |
Commercial | — |  |  | 90,890 |  |  | 90,890 |
Other(1) | 19,880 |  |  | 130,865 |  |  | 150,745 |
Eliminations of intersegment revenues | (92,950 | ) |  | (34,236 | ) |  | (127,186 | )
Total | $ | 10,242,999 |  |  | $ | 1,161,852 |  |  | $ | 11,404,851 |
(1) | Other consists of management service fees earned in the respective Company line of business as well as revenue from the Company's ancillary services and strategic initiatives.
| Year ended December 31, 2017(1)
| U.S. dialysis and related lab services |  | Other - Ancillary services and strategic initiatives |  | Consolidated
Patient service revenues: |  |  |  |  |
Medicare and Medicare Advantage | $ | 5,253,012 |  |  | $ | — |  |  | $ | 5,253,012 |
Medicaid and Managed Medicaid | 606,827 |  |  | — |  |  | 606,827 |
Other government | 362,567 |  |  | 259,651 |  |  | 622,218 |
Commercial | 3,117,920 |  |  | 63,505 |  |  | 3,181,425 |
Other revenues: |  |  |  |  |
Medicare and Medicare Advantage | — |  |  | 902,289 |  |  | 902,289 |
Medicaid and Managed Medicaid | — |  |  | 71,426 |  |  | 71,426 |
Commercial | — |  |  | 116,503 |  |  | 116,503 |
Other(2) | 19,739 |  |  | 182,974 |  |  | 202,713 |
Eliminations of intersegment revenues | (55,176 | ) |  | (24,603 | ) |  | (79,779 | )
Total | $ | 9,304,889 |  |  | $ | 1,571,745 |  |  | $ | 10,876,634 |
(1) | As noted above, prior period amounts have not been adjusted under the cumulative effect method. In this table, the Company's dialysis and related lab services revenues for the year ended December 31, 2017 has been presented net of the provision for uncollectible accounts of $485,364 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 revenue from the Company's ancillary services and strategic initiatives.
| Year ended December 31, 2016(1)
| U.S. dialysis and related lab services |  | Other - Ancillary services and strategic initiatives |  | Consolidated
Patient service revenues: |  |  |  |  |
Medicare and Medicare Advantage | $ | 5,303,718 |  |  | $ | — |  |  | $ | 5,303,718 |
Medicaid and Managed Medicaid | 319,553 |  |  | — |  |  | 319,553 |
Other government | 143,207 |  |  | 165,193 |  |  | 308,400 |
Commercial | 3,355,066 |  |  | 36,674 |  |  | 3,391,740 |
Other revenues: |  |  |  |  |
Medicare and Medicare Advantage | — |  |  | 974,146 |  |  | 974,146 |
Medicaid and Managed Medicaid | — |  |  | 82,428 |  |  | 82,428 |
Commercial | — |  |  | 128,824 |  |  | 128,824 |
Other(2) | 16,645 |  |  | 234,107 |  |  | 250,752 |
Eliminations of intersegment revenues | (27,355 | ) |  | (24,739 | ) |  | (52,094 | )
Total | $ | 9,110,834 |  |  | $ | 1,596,633 |  |  | $ | 10,707,467 |
(1) | As noted above, prior period amounts have not been adjusted under the cumulative effect method. In this table, the Company's dialysis and related lab services revenues for the year ended December 31, 2016 has been presented net of the provision for uncollectible accounts of $431,304 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 revenue from the Company's ancillary services and strategic initiatives.
The Company’s allowance for doubtful accounts related to performance obligations satisfied prior to the adoption of Topic 606 was $52,924 and $218,399 as of December 31, 2018 and 2017, respectively. There are significant risks 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 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. As a result of changes in these estimates, additional revenue was recognized during the year ended December 31, 2018 associated with performance obligations satisfied in years prior to the adoption of Topic 606 of $88,495, which includes a benefit of $36,000 for the year ended December 31, 2018 from electing to apply Topic 606 only to contracts not substantially completed as of January 1, 2018. There is no single commercial payor that accounted for more than 10% of total consolidated accounts receivable or consolidated net revenues at or for the year ended December 31, 2018 and 2017. Net dialysis and related lab services accounts receivable and other receivables from Medicare, including Medicare-assigned plans, and Medicaid, including managed Medicaid plans, were approximately $1,080,561 and $874,971 as of December 31, 2018 and 2017, respectively. Approximately 18% and 21% of the Company’s net patient services accounts receivable balances as of December 31, 2018 and 2017, respectively, were more than six months old. The decrease was primarily due to improved collections at DaVita Health Solutions and in certain international operations. There were no significant balances over one year old at December 31, 2018. Accounts receivable are principally from Medicare and Medicaid programs and commercial insurance plans.

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