XML 21 R9.htm IDEA: XBRL DOCUMENT v3.22.2.2
Revenue Recognition Revenue Recognition
 9 Months Ended
Sep. 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 September 30, 2022Three months ended September 30, 2021
U.S. dialysisOther — Ancillary servicesConsolidatedU.S. dialysisOther — Ancillary servicesConsolidated
Dialysis patient service revenues:
Medicare and Medicare Advantage$1,535,680 $$1,535,680 $1,543,819 $$1,543,819 
Medicaid and Managed Medicaid193,853 193,853 203,169 203,169 
Other government86,852 116,084 202,936 82,624 113,260 195,884 
Commercial880,812 56,170 936,982 862,218 54,857 917,075 
Other revenues:
Medicare and Medicare Advantage78,345 78,345 77,277 77,277 
Medicaid and Managed Medicaid412 412 377 377 
Commercial6,484 6,484 7,164 7,164 
Other(1)
6,056 10,903 16,959 6,216 9,442 15,658 
Eliminations of intersegment revenues(22,957)(22,957)(22,104)(22,104)
Total$2,680,296 $268,398 $2,948,694 $2,675,942 $262,377 $2,938,319 
(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.
Nine months ended September 30, 2022Nine months ended September 30, 2021
U.S. dialysisOther - Ancillary servicesConsolidatedU.S. dialysisOther - Ancillary servicesConsolidated
Dialysis patient service revenues:
Medicare and Medicare Advantage$4,529,300 $$4,529,300 $4,586,278 $$4,586,278 
Medicaid and Managed Medicaid570,380 570,380 585,053 585,053 
Other government253,731 349,633 603,364 245,125 338,553 583,678 
Commercial2,570,054 164,302 2,734,356 2,528,499 157,172 2,685,671 
Other revenues:
Medicare and Medicare Advantage255,204 255,204 243,085 243,085 
Medicaid and Managed Medicaid1,181 1,181 981 981 
Commercial16,029 16,029 14,387 14,387 
Other(1)
18,124 29,584 47,708 19,308 31,107 50,415 
Eliminations of intersegment revenues(64,516)(64,516)(70,424)(4,294)(74,718)
Total$7,877,073 $815,933 $8,693,006 $7,893,839 $780,991 $8,674,830 
(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 (the Company's counterparty), with adjustments where applicable, or on trended or adjusted medical cost targets.