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Revenue Recognition Revenue Recognition | 3 Months Ended
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Mar. 31, 2019
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Revenue Recognition [Text Block] | Revenue recognition The Company’s allowance for doubtful accounts related to performance obligations satisfied in years prior was $42,235 and $52,924 as of March 31, 2019 and December 31, 2018, respectively. 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 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 of $27,179 was recognized during the three months ended March 31, 2019 associated with performance obligations satisfied prior to January 1, 2019. Additional revenue of $67,410 was recognized during the three months ended March 31, 2018 associated with performance obligations satisfied prior to January 1, 2018, which included $24,000 from electing to apply ASC Topic 606 only to contracts not substantially completed as of January 1, 2018. The following table summarizes the Company's segment revenues by primary payor source:
| For the three months ended
| March 31, 2019 |  | March 31, 2018
| U.S. dialysis and related lab services |  | Other - Ancillary services and strategic initiatives |  | Consolidated |  | U.S. dialysis and related lab services |  | Other - Ancillary services and strategic initiatives |  | Consolidated
Patient service revenues: |  |  |  |  |  |  |  |  |  |  |
Medicare and Medicare Advantage | $ | 1,493,516 |  |  | $ | — |  |  | $ | 1,493,516 |  |  | $ | 1,485,192 |  |  | $ | — |  |  | $ | 1,485,192 |
Medicaid and Managed Medicaid | 154,190 |  |  | — |  |  | 154,190 |  |  | 157,496 |  |  | — |  |  | 157,496 |
Other government | 106,127 |  |  | 84,475 |  |  | 190,602 |  |  | 107,119 |  |  | 82,537 |  |  | 189,656 |
Commercial | 788,413 |  |  | 33,388 |  |  | 821,801 |  |  | 782,979 |  |  | 19,718 |  |  | 802,697 |
Other revenues: |  |  |  |  |  |  |  |  |  |  |
Medicare and Medicare Advantage | — |  |  | 61,700 |  |  | 61,700 |  |  | — |  |  | 142,758 |  |  | 142,758 |
Medicaid and Managed Medicaid | — |  |  | 6 |  |  | 6 |  |  | — |  |  | 15,791 |  |  | 15,791 |
Commercial | — |  |  | 32,619 |  |  | 32,619 |  |  | — |  |  | 40,420 |  |  | 40,420 |
Other(1) | 4,905 |  |  | 17,750 |  |  | 22,655 |  |  | 5,114 |  |  | 38,941 |  |  | 44,055 |
Eliminations of intersegment revenues | (30,641 | ) |  | (3,336 | ) |  | (33,977 | ) |  | (18,422 | ) |  | (10,199 | ) |  | (28,621 | )
Total | $ | 2,516,510 |  |  | $ | 226,602 |  |  | $ | 2,743,112 |  |  | $ | 2,519,478 |  |  | $ | 329,966 |  |  | $ | 2,849,444 |
(1) | Other consists of management fees and revenue from the Company's ancillary services and strategic initiatives.
Dialysis and related lab patient service revenues Dialysis and related lab services patient service revenues are recognized in the period services are provided. Revenues consist primarily of payments from Medicare, Medicaid and commercial health plans for dialysis and related lab services provided to patients. A usual and customary fee schedule is maintained for the Company’s 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 the revenues associated with the ancillary services and strategic initiatives, management and administrative support services that are provided to outpatient dialysis centers that the Company does not own or in which the Company owns a noncontrolling interest, and administrative and management support services to certain other non-dialysis joint ventures in which the Company owns a noncontrolling interest.

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