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Revenue Recognition
 12 Months Ended
Dec. 31, 2023
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, 2023
U.S. dialysisOther - Ancillary servicesConsolidated
Patient service revenues:
Medicare and Medicare Advantage$6,100,183 $$6,100,183 
Medicaid and Managed Medicaid833,744 833,744 
Other government354,304 500,137 854,441 
Commercial3,623,516 251,279 3,874,795 
Other revenues:
Medicare and Medicare Advantage460,991 460,991 
Medicaid and Managed Medicaid1,733 1,733 
Commercial32,329 32,329 
Other(1)
25,251 52,754 78,005 
Eliminations of intersegment revenues(88,222)(7,852)(96,074)
Total$10,848,776 $1,291,371 $12,140,147 
    
(1)Consists primarily of management service fees in the Company's U.S. dialysis business and research fees, management fees, and other non-patient service revenues in the Other - ancillary services businesses.
Year ended December 31, 2022
U.S. dialysisOther - Ancillary servicesConsolidated
Patient service revenues:
Medicare and Medicare Advantage$6,041,496 $$6,041,496 
Medicaid and Managed Medicaid759,579 759,579 
Other government336,991 464,921 801,912 
Commercial3,437,306 223,216 3,660,522 
Other revenues:
Medicare and Medicare Advantage345,340 345,340 
Medicaid and Managed Medicaid1,546 1,546 
Commercial22,211 22,211 
Other(1)
24,437 44,092 68,529 
Eliminations of intersegment revenues(87,035)(4,206)(91,241)
Total$10,512,774 $1,097,120 $11,609,894 
(1)Consists primarily of management service fees in the Company's U.S. dialysis business and research fees, management fees, and other non-patient service revenues in the Other - ancillary services businesses.
Year ended December 31, 2021
U.S. dialysisOther - Ancillary servicesConsolidated
Patient service revenues:
Medicare and Medicare Advantage$6,133,235 $$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)Consists primarily of management service fees in the Company's U.S. dialysis business and research fees, management fees, and other non-patient service revenues in the Other - ancillary services businesses.
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. IKC business.
For its IKC business, the Company recognized revenues for performance obligations satisfied in previous years of $94,361, $34,600, and $11,312 during the years ended December 31, 2023, 2022 and 2021, respectively. The delay in recognition of these amounts resulted predominantly from measurement limitations and recognition constraints on our VBC contracts with health plans, many of which are complex and relatively new arrangements. The Company's revenue recognition for its government Comprehensive Kidney Care Contracting (CKCC) program also remains heavily constrained for plan years 2023 and 2022. See Note 1 "Other revenues" for a description of the Company's accounting for these value-based care arrangements.
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 $817,045 and $1,113,499 as of December 31, 2023 and 2022, respectively. Approximately 19% and 18% of the Company’s patient services accounts receivable balances as of December 31, 2023 and 2022, respectively, were more than six months old. There were no significant balances over one year old at December 31, 2023. The Company's accounts receivable are principally due from Medicare and Medicaid programs and commercial insurance plans.