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Revenue Recognition
 12 Months Ended
Dec. 31, 2022
Text Block [Abstract]  
Revenue from Contract with Customer Revenue recognition and accounts receivable
The Company's revenues by segment and primary payor source were as follows:
Year ended December 31, 2022
U.S. dialysisOther - Ancillary servicesConsolidated
Patient service revenues:
Medicare and Medicare Advantage$6,041,496 $6,041,496 
Medicaid and Managed Medicaid759,579 759,579 
Other government336,991 464,921 801,912 
Commercial3,437,306 223,216 3,660,522 
Other revenues:
Medicare and Medicare Advantage345,340 345,340 
Medicaid and Managed Medicaid1,546 1,546 
Commercial22,211 22,211 
Other(1)
24,437 44,092 68,529 
Eliminations of intersegment revenues(87,035)(4,206)(91,241)
Total$10,512,774 $1,097,120 $11,609,894 
    
(1)Other consists primarily 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. IKC and other ancillary services and international operations.
Year ended December 31, 2021
U.S. dialysisOther - Ancillary servicesConsolidated
Patient service revenues:
Medicare and Medicare Advantage$6,133,235 $$6,133,235 
Medicaid and Managed Medicaid782,430 782,430 
Other government328,256 463,385 791,641 
Commercial3,397,697 199,024 3,596,721 
Other revenues:
Medicare and Medicare Advantage326,696 326,696 
Medicaid and Managed Medicaid1,321 1,321 
Commercial15,553 15,553 
Other(1)
25,345 40,945 66,290 
Eliminations of intersegment revenues(90,796)(4,294)(95,090)
Total$10,576,167 $1,042,630 $11,618,797 
(1)Other consists primarily of management service fees earned in the respective Company line of business as well as other non-patient service revenue from the Company's U.S. IKC and other ancillary services and international operations.
Year ended December 31, 2020
U.S. dialysisOther - Ancillary servicesConsolidated
Patient service revenues:
Medicare and Medicare Advantage(1)
$6,169,226 $$6,169,226 
Medicaid and Managed Medicaid744,862 744,862 
Other government(1)
334,714 380,584 715,298 
Commercial3,370,562 170,394 3,540,956 
Other revenues:
Medicare and Medicare Advantage419,662 419,662 
Medicaid and Managed Medicaid1,227 1,227 
Commercial33,246 33,246 
Other(2)
40,571 47,585 88,156 
Eliminations of intersegment revenues(145,286)(16,743)(162,029)
Total$10,514,649 $1,035,955 $11,550,604 
(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 year ended December 31, 2020 has also been recast to conform to this presentation.
(2)Other consists primarily of management service fees earned in the respective Company line of business as well as other non-patient revenue from the Company's U.S. IKC and other ancillary services and international operations.
The majority of the Company's non-patient service revenues from Medicare and Medicare Advantage, Medicaid and Managed Medicaid, and commercial sources represent risk-based revenues earned by the Company's U.S. integrated care and disease management business.
As described in Note 1, there are significant risks associated with estimating revenue, many of which 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 determining applicable primary and secondary coverage, changes in patient 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.
No single commercial payor accounted for more than 10% of consolidated revenues or consolidated accounts receivable for the periods presented in these consolidated financial statements or at their period-ends, respectively. 
Dialysis services accounts receivable and other receivables from Medicare, including Medicare Advantage plans, and Medicaid, including managed Medicaid plans, were approximately $1,113,499 and $1,174,123 as of December 31, 2022 and 2021, respectively. Approximately 18% and 16% of the Company’s patient services accounts receivable balances as of December 31, 2022 and 2021, respectively, were more than six months old. There were no significant balances over one year old at December 31, 2022. The Company's accounts receivable are principally due from Medicare and Medicaid programs and commercial insurance plans.