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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, 2021Three months ended September 30, 2020
U.S. dialysisOther - Ancillary servicesConsolidatedU.S. dialysisOther - Ancillary servicesConsolidated
Dialysis patient service revenues:
Medicare and Medicare Advantage(1)
$1,543,819 $$1,543,819 $1,541,707 $$1,541,707 
Medicaid and Managed Medicaid203,169 203,169 193,254 193,254 
Other government(1)
82,624 113,260 195,884 83,602 98,044 181,646 
Commercial862,218 54,857 917,075 858,247 43,845 902,092 
Other revenues:
Medicare and Medicare Advantage77,277 77,277 111,248 111,248 
Medicaid and Managed Medicaid377 377 412 412 
Commercial7,164 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, 2021Nine months ended September 30, 2020
U.S. dialysisOther - Ancillary servicesConsolidatedU.S. dialysisOther - Ancillary servicesConsolidated
Dialysis patient service revenues:
Medicare and Medicare Advantage(1)
$4,586,278 $$4,586,278 $4,619,852 $$4,619,852 
Medicaid and Managed Medicaid585,053 585,053 547,045 547,045 
Other government(1)
245,125 338,553 583,678 253,654 283,431 537,085 
Commercial2,528,499 157,172 2,685,671 2,534,388 118,869 2,653,257 
Other revenues:
Medicare and Medicare Advantage243,085 243,085 309,555 309,555 
Medicaid and Managed Medicaid981 981 1,061 1,061 
Commercial14,387 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.