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Revenue Recognition | 12 Months Ended
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Dec. 31, 2019
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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, 2019
| U.S. dialysis |  | Other - Ancillary services |  | Consolidated
Patient service revenues: |  |  |  |  |
Medicare and Medicare Advantage | $ | 6,129,697 |  |  | $ |  | $ | 6,129,697 |
Medicaid and Managed Medicaid | 669,089 |  |  |  |  | 669,089 |
Other government | 446,010 |  |  | 352,765 |  |  | 798,775 |
Commercial | 3,286,089 |  |  | 144,256 |  |  | 3,430,345 |
Other revenues: |  |  |  |  |
Medicare and Medicare Advantage |  |  | 264,538 |  |  | 264,538 |
Medicaid and Managed Medicaid |  |  | 606 |  |  | 606 |
Commercial |  |  | 130,823 |  |  | 130,823 |
Other(1) | 32,021 |  |  | 78,940 |  |  | 110,961 |
Eliminations of intersegment revenues | (132,325 | ) |  | (14,030 | ) |  | (146,355 | )
Total | $ | 10,430,581 |  |  | $ | 957,898 |  |  | $ | 11,388,479 |
(1) | Other consists of management service fees earned in the respective Company line of business as well as other revenue from the Company's ancillary services.
| Year ended December 31, 2018
| U.S. dialysis |  | Other - Ancillary services |  | 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 other revenue from the Company's ancillary services.
| Year ended December 31, 2017(1)
| U.S. dialysis |  | Other - Ancillary services |  | 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 U.S. dialysis 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 other revenue from the Company's ancillary services.
The Company’s allowance for doubtful accounts related to performance obligations satisfied prior to the adoption of Topic 606 was $8,328 and $52,924 as of December 31, 2019 and 2018, respectively. As described in Note 1, there are significant risks 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 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 these changes in estimates, additional revenue of $37,274 was recognized during the year ended December 31, 2019 associated with performance obligations satisfied prior to January 1, 2019 and additional revenue of $88,495 was recognized during the year ended December 31, 2018 associated with performance obligations satisfied in years prior to the adoption of Topic 606, which included a benefit of $36,000 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 revenues at or for the years ended December 31, 2019 or 2018. Net dialysis services accounts receivable and other receivables from Medicare, including Medicare-assigned plans, and Medicaid, including managed Medicaid plans, were approximately $1,038,248 and $1,080,561 as of December 31, 2019 and 2018, respectively. Approximately 18% of the Company’s net patient services accounts receivable balances as of both December 31, 2019 and 2018, were more than six months old. There were no significant balances over one year old at December 31, 2019. The Company's accounts receivable are principally due from Medicare and Medicaid programs and commercial insurance plans.

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