XML 21 R9.htm IDEA: XBRL DOCUMENT v3.21.2
Revenue Recognition Revenue Recognition
 6 Months Ended
Jun. 30, 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 June 30, 2021Three months ended June 30, 2020
U.S. dialysisOther - Ancillary servicesConsolidatedU.S. dialysisOther - Ancillary servicesConsolidated
Dialysis patient service revenues:
Medicare and Medicare Advantage(1)
$1,562,164 $$1,562,164 $1,547,113 $$1,547,113 
Medicaid and Managed Medicaid194,641 194,641 182,324 182,324 
Other government(1)
82,317 118,464 200,781 86,954 90,813 177,767 
Commercial830,801 50,817 881,618 850,558 35,557 886,115 
Other revenues:
Medicare and Medicare Advantage80,211 80,211 99,829 99,829 
Medicaid and Managed Medicaid305 305 283 283 
Commercial1,189 1,189 9,050 9,050 
Other(2)
6,415 10,503 16,918 7,995 9,103 17,098 
Eliminations of intersegment revenues(21,317)— (21,317)(35,429)(4,171)(39,600)
Total$2,655,021 $261,489 $2,916,510 $2,639,515 $240,464 $2,879,979 
(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 June 30, 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.
Six months ended June 30, 2021Six months ended June 30, 2020
U.S. dialysisOther - Ancillary servicesConsolidatedU.S. dialysisOther - Ancillary servicesConsolidated
Dialysis patient service revenues:
Medicare and Medicare Advantage(1)
$3,042,461 $$3,042,461 $3,078,146 $$3,078,146 
Medicaid and Managed Medicaid381,884 381,884 353,791 353,791 
Other government(1)
162,501 225,293 387,794 170,052 185,387 355,439 
Commercial1,666,280 102,315 1,768,595 1,676,140 75,024 1,751,164 
Other revenues:
Medicare and Medicare Advantage165,807 165,807 198,307 198,307 
Medicaid and Managed Medicaid605 605 649 649 
Commercial7,223 7,223 19,571 19,571 
Other(2)
13,091 21,665 34,756 13,438 26,705 40,143 
Eliminations of intersegment revenues(48,320)(4,294)(52,614)(67,670)(8,324)(75,994)
Total$5,217,897 $518,614 $5,736,511 $5,223,897 $497,319 $5,721,216 
(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 six months ended June 30, 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.