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Revenue Recognition Revenue Recognition
 6 Months Ended
Jun. 30, 2023
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, 2023Three months ended June 30, 2022
U.S. dialysisOther — Ancillary servicesConsolidatedU.S. dialysisOther — Ancillary servicesConsolidated
Dialysis patient service revenues:
Medicare and Medicare Advantage$1,539,639 $1,539,639 $1,529,534 $1,529,534 
Medicaid and Managed Medicaid216,014 216,014 186,873 186,873 
Other government92,525 $125,964 218,489 86,079 $116,653 202,732 
Commercial876,033 60,871 936,904 854,662 55,708 910,370 
Other revenues:
Medicare and Medicare Advantage87,236 87,236 93,262 93,262 
Medicaid and Managed Medicaid396 396 232 232 
Commercial3,619 3,619 8,207 8,207 
Other(1)
6,404 13,437 19,841 6,092 8,844 14,936 
Eliminations of intersegment revenues(20,361)(1,408)(21,769)(19,389)(19,389)
Total$2,710,254 $290,115 $3,000,369 $2,643,851 $282,906 $2,926,757 
(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. integrated kidney care (IKC) and other ancillary services and international operations.
Six months ended June 30, 2023Six months ended June 30, 2022
U.S. dialysisOther — Ancillary servicesConsolidatedU.S. dialysisOther — Ancillary servicesConsolidated
Dialysis patient service revenues:
Medicare and Medicare Advantage$3,022,405 $3,022,405 $2,993,621 $2,993,621 
Medicaid and Managed Medicaid421,790 421,790 376,528 376,528 
Other government174,570 $247,550 422,120 166,879 $233,548 400,427 
Commercial1,711,427 115,387 1,826,814 1,689,240 108,132 1,797,372 
Other revenues:
Medicare and Medicare Advantage180,475 180,475 176,859 176,859 
Medicaid and Managed Medicaid965 965 769 769 
Commercial4,825 4,825 9,546 9,546 
Other(1)
12,583 26,275 38,858 12,068 18,680 30,748 
Eliminations of intersegment revenues(42,410)(2,774)(45,184)(41,558)(41,558)
Total$5,300,365 $572,703 $5,873,068 $5,196,778 $547,534 $5,744,312 
(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. integrated kidney care (IKC) and other ancillary services and international operations.
There are significant uncertainties 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 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 integrated kidney care (IKC) revenues include revenues earned under risk-based arrangements, 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.