XML 22 R9.htm IDEA: XBRL DOCUMENT
v3.21.2

Revenue Recognition Revenue Recognition | 9 Months Ended
--- | ---
Sep. 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 September 30, 2021 |  | Three months ended September 30, 2020
| U.S. dialysis |  | Other - Ancillary services |  | Consolidated |  | U.S. dialysis |  | Other - Ancillary services |  | Consolidated
Dialysis patient service revenues: |  |  |  |  |  |  |  |  |  |  |
Medicare and Medicare Advantage(1) | $ | 1,543,819 |  |  | $ |  | $ | 1,543,819 |  |  | $ | 1,541,707 |  |  | $ |  | $ | 1,541,707 |
Medicaid and Managed Medicaid | 203,169 |  |  |  |  | 203,169 |  |  | 193,254 |  |  |  |  | 193,254 |
Other government(1) | 82,624 |  |  | 113,260 |  |  | 195,884 |  |  | 83,602 |  |  | 98,044 |  |  | 181,646 |
Commercial | 862,218 |  |  | 54,857 |  |  | 917,075 |  |  | 858,247 |  |  | 43,845 |  |  | 902,092 |
Other revenues: |  |  |  |  |  |  |  |  |  |  |
Medicare and Medicare Advantage |  |  | 77,277 |  |  | 77,277 |  |  |  |  | 111,248 |  |  | 111,248 |
Medicaid and Managed Medicaid |  |  | 377 |  |  | 377 |  |  |  |  | 412 |  |  | 412 |
Commercial |  |  | 7,164 |  |  | 7,164 |  |  |  |  | 7,799 |  |  | 7,799 |
Other(2) | 6,216 |  |  | 9,442 |  |  | 15,658 |  |  | 17,409 |  |  | 9,895 |  |  | 27,304 |
Eliminations of intersegment revenues | (22,104) |  |  | — |  |  | (22,104) |  |  | (37,317) |  |  | (4,079) |  |  | (41,396) |
Total | $ | 2,675,942 |  |  | $ | 262,377 |  |  | $ | 2,938,319 |  |  | $ | 2,656,902 |  |  | $ | 267,164 |  |  | $ | 2,924,066 |
(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 September 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.
| Nine months ended September 30, 2021 |  | Nine months ended September 30, 2020
| U.S. dialysis |  | Other - Ancillary services |  | Consolidated |  | U.S. dialysis |  | Other - Ancillary services |  | Consolidated
Dialysis patient service revenues: |  |  |  |  |  |  |  |  |  |  |
Medicare and Medicare Advantage(1) | $ | 4,586,278 |  |  | $ |  | $ | 4,586,278 |  |  | $ | 4,619,852 |  |  | $ |  | $ | 4,619,852 |
Medicaid and Managed Medicaid | 585,053 |  |  |  |  | 585,053 |  |  | 547,045 |  |  |  |  | 547,045 |
Other government(1) | 245,125 |  |  | 338,553 |  |  | 583,678 |  |  | 253,654 |  |  | 283,431 |  |  | 537,085 |
Commercial | 2,528,499 |  |  | 157,172 |  |  | 2,685,671 |  |  | 2,534,388 |  |  | 118,869 |  |  | 2,653,257 |
Other revenues: |  |  |  |  |  |  |  |  |  |  |
Medicare and Medicare Advantage |  |  | 243,085 |  |  | 243,085 |  |  |  |  | 309,555 |  |  | 309,555 |
Medicaid and Managed Medicaid |  |  | 981 |  |  | 981 |  |  |  |  | 1,061 |  |  | 1,061 |
Commercial |  |  | 14,387 |  |  | 14,387 |  |  |  |  | 27,370 |  |  | 27,370 |
Other(2) | 19,308 |  |  | 31,107 |  |  | 50,415 |  |  | 30,846 |  |  | 36,600 |  |  | 67,446 |
Eliminations of intersegment revenues | (70,424) |  |  | (4,294) |  |  | (74,718) |  |  | (104,987) |  |  | (12,402) |  |  | (117,389) |
Total | $ | 7,893,839 |  |  | $ | 780,991 |  |  | $ | 8,674,830 |  |  | $ | 7,880,798 |  |  | $ | 764,484 |  |  | $ | 8,645,282 |
(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 nine months ended September 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.

X
- Definition The entire disclosure of revenue from contract with customer to transfer good or service and to transfer nonfinancial asset. Includes, but is not limited to, disaggregation of revenue, credit loss recognized from contract with customer, judgment and change in judgment related to contract with customer, and asset recognized from cost incurred to obtain or fulfill contract with customer. Excludes insurance and lease contracts. + References Reference 1: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 606 -URI http://asc.fasb.org/topic&trid=49130388 Reference 2: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 606 -SubTopic 10 -Section 50 -Paragraph 10 -URI http://asc.fasb.org/extlink&oid=123351226&loc=SL49130551-203045 Reference 3: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 606 -SubTopic 10 -Section 50 -Paragraph 13 -Subparagraph (b)(2) -URI http://asc.fasb.org/extlink&oid=123351226&loc=SL49130556-203045 Reference 4: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 606 -SubTopic 10 -Section 50 -Paragraph 12 -Subparagraph (b) -URI http://asc.fasb.org/extlink&oid=123351226&loc=SL49130554-203045 Reference 5: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 606 -SubTopic 10 -Section 50 -Paragraph 9 -URI http://asc.fasb.org/extlink&oid=123351226&loc=SL49130550-203045 Reference 6: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 606 -SubTopic 10 -Section 50 -Paragraph 12 -Subparagraph (e) -URI http://asc.fasb.org/extlink&oid=123351226&loc=SL49130554-203045 Reference 7: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 606 -SubTopic 10 -Section 50 -Paragraph 12 -Subparagraph (a) -URI http://asc.fasb.org/extlink&oid=123351226&loc=SL49130554-203045 Reference 8: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 606 -SubTopic 10 -Section 50 -Paragraph 12 -Subparagraph (d) -URI http://asc.fasb.org/extlink&oid=123351226&loc=SL49130554-203045 Reference 9: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 606 -SubTopic 10 -Section 50 -Paragraph 15 -URI http://asc.fasb.org/extlink&oid=123351226&loc=SL49130558-203045 Reference 10: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 606 -SubTopic 10 -Section 50 -Paragraph 12 -Subparagraph (c) -URI http://asc.fasb.org/extlink&oid=123351226&loc=SL49130554-203045 + Details
Name: | us-gaap_RevenueFromContractWithCustomerTextBlock
Namespace Prefix: | us-gaap_
Data Type: | dtr-types:textBlockItemType
Balance Type: | na
Period Type: | duration

X
- References No definition available. + Details
Name: | us-gaap_TextBlockAbstract
Namespace Prefix: | us-gaap_
Data Type: | xbrli:stringItemType
Balance Type: | na
Period Type: | duration