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Revenue Recognition Revenue Recognition
 3 Months Ended
Mar. 31, 2021
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 March 31, 2021Three months ended March 31, 2020
U.S. dialysisOther - Ancillary servicesConsolidatedU.S. dialysisOther - Ancillary servicesConsolidated
Dialysis patient service revenues:
Medicare and Medicare Advantage(1)
$1,480,297 $$1,480,297 $1,531,033 $$1,531,033 
Medicaid and Managed Medicaid187,243 187,243 171,467 171,467 
Other government(1)
80,184 106,830 187,014 83,099 94,574 177,673 
Commercial835,479 51,498 886,977 825,582 39,467 865,049 
Other revenues:
Medicare and Medicare Advantage85,595 85,595 98,478 98,478 
Medicaid and Managed Medicaid300 300 366 366 
Commercial6,034 6,034 10,521 10,521 
Other(2)
6,675 11,162 17,837 5,442 17,602 23,044 
Eliminations of intersegment revenues(27,003)(4,293)(31,296)(32,242)(4,152)(36,394)
Total$2,562,875 $257,126 $2,820,001 $2,584,381 $256,856 $2,841,237 
(1)During the first quarter of 2021, the Company realigned the classification of revenue previously disclosed in the “Other government” category to the “Medicare and Medicare Advantage” category for certain government-reimbursed plans which have structure and payment characteristics similar to traditional Medicare Advantage plans. The classification of revenue for these plans for the three months ended March 31, 2020 has also been recast 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.
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 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 businesses that the Company does not own or in which the Company owns a noncontrolling interest as well as revenues associated with the Company's non-dialysis ancillary services. Revenues associated with dialysis management services, integrated care services, clinical research programs, physician services, and end stage renal disease (ESRD) seamless care organizations are estimated and recognized in the period services are provided.