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Revenue Recognition | 12 Months Ended
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Dec. 31, 2024
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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, 2024
| U.S. dialysis |  | Other - Ancillary services |  | Consolidated
Patient service revenues: |  |  |  |  |
Medicare and Medicare Advantage | $ | 6,374,882 |  |  | $ |  | $ | 6,374,882 |
Medicaid and Managed Medicaid | 863,947 |  |  |  |  | 863,947 |
Other government | 343,705 |  |  | 717,735 |  |  | 1,061,440 |
Commercial | 3,783,827 |  |  | 248,026 |  |  | 4,031,853 |
Other revenues: |  |  |  |  |
Medicare and Medicare Advantage |  |  | 463,731 |  |  | 463,731 |
Medicaid and Managed Medicaid |  |  | 740 |  |  | 740 |
Commercial |  |  | 21,396 |  |  | 21,396 |
Other(1) | 24,356 |  |  | 58,862 |  |  | 83,218 |
Eliminations of intersegment revenues | (71,747) |  |  | (13,910) |  |  | (85,657) |
Total | $ | 11,318,970 |  |  | $ | 1,496,580 |  |  | $ | 12,815,550 |
| Year ended December 31, 2023
| U.S. dialysis |  | Other - Ancillary services |  | Consolidated
Patient service revenues: |  |  |  |  |
Medicare and Medicare Advantage | $ | 6,100,183 |  |  | $ |  | $ | 6,100,183 |
Medicaid and Managed Medicaid | 833,744 |  |  |  |  | 833,744 |
Other government | 354,304 |  |  | 500,137 |  |  | 854,441 |
Commercial | 3,623,516 |  |  | 251,279 |  |  | 3,874,795 |
Other revenues: |  |  |  |  |
Medicare and Medicare Advantage |  |  | 460,991 |  |  | 460,991 |
Medicaid and Managed Medicaid |  |  | 1,733 |  |  | 1,733 |
Commercial |  |  | 32,329 |  |  | 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 |
| Year ended December 31, 2022
| U.S. dialysis |  | Other - Ancillary services |  | Consolidated
Patient service revenues: |  |  |  |  |
Medicare and Medicare Advantage | $ | 6,041,496 |  |  | $ |  | $ | 6,041,496 |
Medicaid and Managed Medicaid | 759,579 |  |  |  |  | 759,579 |
Other government | 336,991 |  |  | 464,921 |  |  | 801,912 |
Commercial | 3,437,306 |  |  | 223,216 |  |  | 3,660,522 |
Other revenues: |  |  |  |  |
Medicare and Medicare Advantage |  |  | 345,340 |  |  | 345,340 |
Medicaid and Managed Medicaid |  |  | 1,546 |  |  | 1,546 |
Commercial |  |  | 22,211 |  |  | 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. 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 $116,336, $94,361, and $34,600 during the years ended December 31, 2024, 2023 and 2022, respectively. The delay in recognition of these amounts resulted predominantly from measurement limitations and recognition constraints on both the Company's VBC contracts with health plans, many of which are complex and relatively new arrangements, as well as its government Comprehensive Kidney Care Contracting (CKCC) program. The Company's revenue recognition for its government CKCC program also remains heavily constrained for plan year 2024. 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 $833,464 and $817,045 as of December 31, 2024 and 2023, respectively. Approximately 23% and 19% of the Company’s U.S. dialysis accounts receivable balances as of December 31, 2024 and 2023, respectively, were more than six months old. There were no significant balances over one year old at December 31, 2024. The Company's accounts receivable are principally due from Medicare and Medicaid programs and commercial insurance plans.

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- Definition The entire disclosure of revenue from contract with customer to transfer good or service and to transfer nonfinancial asset. Includes, but is not limited to, disaggregation of revenue, credit loss recognized from contract with customer, judgment and change in judgment related to contract with customer, and asset recognized from cost incurred to obtain or fulfill contract with customer. Excludes insurance and lease contracts. + References Reference 1: http://www.xbrl.org/2003/role/disclosureRef -Topic 606 -SubTopic 10 -Name Accounting Standards Codification -Section 50 -Paragraph 9 -Publisher FASB -URI https://asc.fasb.org/1943274/2147479806/606-10-50-9 Reference 2: http://www.xbrl.org/2003/role/disclosureRef -Topic 606 -SubTopic 10 -Name Accounting Standards Codification -Section 50 -Paragraph 10 -Publisher FASB -URI https://asc.fasb.org/1943274/2147479806/606-10-50-10 Reference 3: http://www.xbrl.org/2003/role/disclosureRef -Topic 606 -SubTopic 10 -Name Accounting Standards Codification -Section 50 -Paragraph 15 -Publisher FASB -URI https://asc.fasb.org/1943274/2147479806/606-10-50-15 Reference 4: http://www.xbrl.org/2003/role/disclosureRef -Topic 606 -SubTopic 10 -Name Accounting Standards Codification -Section 50 -Paragraph 12 -Subparagraph (a) -Publisher FASB -URI https://asc.fasb.org/1943274/2147479806/606-10-50-12 Reference 5: http://www.xbrl.org/2003/role/disclosureRef -Topic 606 -SubTopic 10 -Name Accounting Standards Codification -Section 50 -Paragraph 12 -Subparagraph (b) -Publisher FASB -URI https://asc.fasb.org/1943274/2147479806/606-10-50-12 Reference 6: http://www.xbrl.org/2003/role/disclosureRef -Topic 606 -SubTopic 10 -Name Accounting Standards Codification -Section 50 -Paragraph 12 -Subparagraph (c) -Publisher FASB -URI https://asc.fasb.org/1943274/2147479806/606-10-50-12 Reference 7: http://www.xbrl.org/2003/role/disclosureRef -Topic 606 -SubTopic 10 -Name Accounting Standards Codification -Section 50 -Paragraph 12 -Subparagraph (d) -Publisher FASB -URI https://asc.fasb.org/1943274/2147479806/606-10-50-12 Reference 8: http://www.xbrl.org/2003/role/disclosureRef -Topic 606 -SubTopic 10 -Name Accounting Standards Codification -Section 50 -Paragraph 12 -Subparagraph (e) -Publisher FASB -URI https://asc.fasb.org/1943274/2147479806/606-10-50-12 Reference 9: http://www.xbrl.org/2003/role/disclosureRef -Topic 606 -SubTopic 10 -Name Accounting Standards Codification -Section 50 -Paragraph 13 -Subparagraph (b)(2) -Publisher FASB -URI https://asc.fasb.org/1943274/2147479806/606-10-50-13 Reference 10: http://www.xbrl.org/2003/role/disclosureRef -Name Accounting Standards Codification -Topic 606 -Publisher FASB -URI https://asc.fasb.org/606/tableOfContent + Details
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