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Revenue Recognition Revenue Recognition
 6 Months Ended
Jun. 30, 2022
Text Block [Abstract]  
Revenue Recognition [Text Block] Revenue recognition
The following tables summarize the Company's segment revenues by primary payor source:
Three months ended June 30, 2022Three months ended June 30, 2021
U.S. dialysisOther — Ancillary servicesConsolidatedU.S. dialysisOther — Ancillary servicesConsolidated
Dialysis patient service revenues:
Medicare and Medicare Advantage$1,529,534 $$1,529,534 $1,562,164 $$1,562,164 
Medicaid and Managed Medicaid186,873 186,873 194,641 194,641 
Other government86,079 116,653 202,732 82,317 118,464 200,781 
Commercial854,662 55,708 910,370 830,801 50,817 881,618 
Other revenues:
Medicare and Medicare Advantage93,262 93,262 80,211 80,211 
Medicaid and Managed Medicaid232 232 305 305 
Commercial8,207 8,207 1,189 1,189 
Other(1)
6,092 8,844 14,936 6,415 10,503 16,918 
Eliminations of intersegment revenues(19,389)(19,389)(21,317)— (21,317)
Total$2,643,851 $282,906 $2,926,757 $2,655,021 $261,489 $2,916,510 
(1)Other primarily consists of management service fees earned in the respective Company line of business as well as other non-patient service revenue from the Company's U.S. ancillary services and international operations.
Six months ended June 30, 2022Six months ended June 30, 2021
U.S. dialysisOther - Ancillary servicesConsolidatedU.S. dialysisOther - Ancillary servicesConsolidated
Dialysis patient service revenues:
Medicare and Medicare Advantage$2,993,621 $$2,993,621 $3,042,461 $$3,042,461 
Medicaid and Managed Medicaid376,528 376,528 381,884 381,884 
Other government166,879 233,548 400,427 162,501 225,293 387,794 
Commercial1,689,240 108,132 1,797,372 1,666,280 102,315 1,768,595 
Other revenues:
Medicare and Medicare Advantage176,859 176,859 165,807 165,807 
Medicaid and Managed Medicaid769 769 605 605 
Commercial9,546 9,546 7,223 7,223 
Other(1)
12,068 18,680 30,748 13,091 21,665 34,756 
Eliminations of intersegment revenues(41,558)(41,558)(48,320)(4,294)(52,614)
Total$5,196,778 $547,534 $5,744,312 $5,217,897 $518,614 $5,736,511 
(1)    Other primarily consists of management service fees earned in the respective Company line of business as well as other non-patient service revenue from the Company's U.S. ancillary services and international operations.
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. The Company maintains a usual and customary fee schedule for its 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 revenues earned by the Company's non-dialysis ancillary services as well as fees for management and administrative services to outpatient dialysis businesses that the Company does not consolidate. Other revenues are estimated in the period services are provided. The Company's U.S. ancillary service revenues include revenues earned under risk-based arrangements in the Company's integrated kidney care (IKC) business, including value-based care (VBC) arrangements. Under its VBC arrangements, the Company assumes full or shared financial risk for the total medical cost of care for patients below or above a benchmark. The benchmarks against which the Company incurs profit or loss on these contracts are typically based on the underlying premiums paid to the insuring entity (our counterparty), with adjustments where applicable, or on trended or adjusted medical cost targets.