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Revenue Recognition Revenue Recognition
 6 Months Ended
Jun. 30, 2020
Text Block [Abstract]  
Revenue Recognition [Text Block]
Revenue recognition
The following table summarizes the Company's segment revenues by primary payor source:
 
Three months ended June 30, 2020
 
Three months ended June 30, 2019
 
U.S. dialysis
 
Other - Ancillary services
 
Consolidated
 
U.S. dialysis
 
Other - Ancillary services
 
Consolidated
Dialysis patient service revenues:
 
 
 
 
 
 
 
 
 
 
 
Medicare and Medicare Advantage
$
1,517,309

 
$
 
$
1,517,309

 
$
1,520,193

 
$
 
$
1,520,193

Medicaid and Managed Medicaid
182,324

 


 
182,324

 
160,242

 

 
160,242

Other government
116,758

 
90,813

 
207,571

 
110,565

 
88,770

 
199,335

Commercial
850,558

 
35,557

 
886,115

 
840,993

 
33,095

 
874,088

Other revenues:
 
 
 
 
 
 
 
 
 
 
 
Medicare and Medicare Advantage


 
99,829

 
99,829

 

 
64,012

 
64,012

Medicaid and Managed Medicaid


 
283

 
283

 

 
94

 
94

Commercial


 
9,050

 
9,050

 

 
32,307

 
32,307

Other(1)
7,995

 
9,103

 
17,098

 
5,501

 
20,670

 
26,171

Eliminations of intersegment revenues
(35,429
)
 
(4,171
)
 
(39,600
)
 
(30,334
)
 
(3,403
)
 
(33,737
)
Total
$
2,639,515

 
$
240,464

 
$
2,879,979

 
$
2,607,160

 
$
235,545

 
$
2,842,705


(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.
 
Six months ended June 30, 2020
 
Six months ended June 30, 2019
 
U.S. dialysis
 
Other - Ancillary services
 
Consolidated
 
U.S. dialysis
 
Other - Ancillary services
 
Consolidated
Patient service revenues:
 
 
 
 
 
 
 
 
 
 
 
Medicare and Medicare Advantage
$
3,019,529

 
$
 
$
3,019,529

 
$
3,013,709

 
$
 
$
3,013,709

Medicaid and Managed Medicaid
353,791

 
 
 
353,791

 
314,431

 
 
 
314,431

Other government
228,669

 
185,387

 
414,056

 
216,692

 
173,245

 
389,937

Commercial
1,676,140

 
75,024

 
1,751,164

 
1,629,407

 
66,483

 
1,695,890

Other revenues:
 
 
 
 
 
 
 
 
 
 
 
Medicare and Medicare Advantage
 
 
198,307

 
198,307

 
 
 
125,713

 
125,713

Medicaid and Managed Medicaid
 
 
649

 
649

 
 
 
100

 
100

Commercial
 
 
19,571

 
19,571

 
 
 
64,925

 
64,925

Other(1)
13,438

 
26,705

 
40,143

 
10,406

 
38,420

 
48,826

Eliminations of intersegment revenues
(67,670
)
 
(8,324
)
 
(75,994
)
 
(60,975
)
 
(6,739
)
 
(67,714
)
Total
$
5,223,897

 
$
497,319

 
$
5,721,216

 
$
5,123,670

 
$
462,147

 
$
5,585,817


(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.
The Company’s allowance for doubtful accounts related to performance obligations satisfied in years prior to January 1, 2018 was $1,906 and $8,328 as of June 30, 2020 and December 31, 2019, 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, without limitation, 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. 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 fees for management and administrative support services provided to outpatient dialysis centers that the Company does not own or in which the Company owns a noncontrolling interest, revenues associated with the Company's non-dialysis ancillary services, and administrative and management support services to certain non-dialysis joint ventures in which the Company owns a noncontrolling interest.