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Summary of Significant Accounting Policies (Tables) | 3 Months Ended
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Mar. 31, 2019
Accounting Policies [Abstract] |
Revision of Previously Reported Financial Information | The following tables presents the impact of the revision on the changes in the contractual allowance and allowance for doubtful accounts balances for the interim periods in the year ended December 31, 2018 (in thousands):
|  | Three Months Ended March 31, 2018 |  |  | Six Months Ended June 30, 2018 |  |  | Nine Months Ended September 30, 2018 |
Allowance for doubtful accounts |  | As reported |  |  | As revised (1) |  |  | As reported |  |  | As revised (2) |  |  | As reported |  |  | As revised (3) |
Balance, beginning of period |  | $ | 3,568 |  |  | $ | 3,568 |  |  | $ | 3,568 |  |  | $ | 3,568 |  |  | $ | 3,568 |  |  | $ | 3,568 |
Add: provision for doubtful accounts |  |  | 1,691 |  |  |  | 325 |  |  |  | 3,822 |  |  |  | 1,791 |  |  |  | 5,917 |  |  |  | 3,254 |
Less: write-offs, net of recoveries and other adjustments |  |  | 5 |  |  |  | 5 |  |  |  | (2,526 | ) |  |  | (2,526 | ) |  |  | (2,514 | ) |  |  | (2,514 | )
Balance, end of period |  | $ | 5,264 |  |  | $ | 3,898 |  |  | $ | 4,864 |  |  | $ | 2,833 |  |  | $ | 6,971 |  |  | $ | 4,308 |
|  | Three Months Ended March 31, 2018 |  |  | Six Months Ended June 30, 2018 |  |  | Nine Months Ended September 30, 2018 |
Contractual Allowance |  | As reported |  |  | As revised (1) |  |  | As reported |  |  | As revised (2) |  |  | As reported |  |  | As revised (3) |
Balance, beginning of period |  | $ | 7,444 |  |  | $ | 7,444 |  |  | $ | 7,444 |  |  | $ | 7,444 |  |  | $ | 7,444 |  |  | $ | 7,444 |
Add: allowance for contractual adjustments |  |  | 989 |  |  |  | 2,355 |  |  |  | 2,618 |  |  |  | 4,649 |  |  |  | 3,004 |  |  |  | 6,256 |
Less: contractual adjustments |  |  | 18 |  |  |  | 18 |  |  |  | (3,072 | ) |  |  | (3,072 | ) |  |  | (2,467 | ) |  |  | (3,056 | )
Balance, end of period |  | $ | 8,451 |  |  | $ | 9,817 |  |  | $ | 6,990 |  |  | $ | 9,021 |  |  | $ | 7,981 |  |  | $ | 10,644 |
Note that the above adjustments did not result in any changes to the Company’s total receivables-related reserves for the periods in the table above. (1) For the three months ended March 31, 2018, the allowance for contractual adjustments was increased by $1.4 million and the provision for doubtful accounts was reduced by the same amount. (2) For the six months ended June 30, 2018, the allowance for contractual adjustments was increased by $2.0 million and the provision for doubtful accounts was reduced by the same amount. (3) For the nine months ended September 31, 2018, the allowance for contractual adjustments was increased by $2.7 million and the provision for doubtful accounts was reduced by the same amount. In addition, in the contractual allowances table, contractual adjustments were increased by $0.6 million and the allowance for contractual adjustments was reduced by the same amount.
Schedule of Changes in Allowance for Doubtful Accounts | The following table presents the changes in the allowance for doubtful accounts (in thousands):
|  | Three Months Ended March 31, |  |  | Year Ended December 31, |
|  | 2019 |  |  | 2018 |
Balance, beginning of period |  | $ | 4,851 |  |  | $ | 3,568 |
Add: provision for doubtful accounts |  |  | 828 |  |  |  | 5,826 |
Less: write-offs, net of recoveries and other adjustments |  |  | (1,346 | ) |  |  | (4,543 | )
Balance, end of period |  | $ | 4,333 |  |  | $ | 4,851 |
Schedule of Changes in Contractual Allowance | The following table presents the changes in the contractual allowance (in thousands):
|  | Three Months Ended March 31, |  |  | Year Ended December 31, |
|  | 2019 |  |  | 2018 |
Balance, beginning of period |  | $ | 10,601 |  |  | $ | 7,444 |
Add: allowance for contractual adjustments |  |  | 3,881 |  |  |  | 9,392 |
Less: contractual adjustments |  |  | (1,435 | ) |  |  | (6,235 | )
Balance, end of period |  | $ | 13,047 |  |  | $ | 10,601 |
Schedule of Impact of Allowance for Doubtful Accounts and Contractual Allowance on Accounts Receivable | The following table presents the impact of allowance for doubtful accounts and contractual allowance on accounts receivable (in thousands):
| Three Months Ended March 31, |  |  | Year Ended December 31, |
| 2019 |  |  | 2018 |
Gross accounts receivable | $ | 45,632 |  |  | $ | 37,429 |
Less: allowance for doubtful accounts |  | (4,333 | ) |  |  | (4,851 | )
Less: contractual allowance |  | (13,047 | ) |  |  | (10,601 | )
Net accounts receivable | $ | 28,252 |  |  | $ | 21,977 |
Disaggregated Revenue by Payor Type and Major Service | The Company disaggregates revenue from contracts with customers by payor type. The Company believes these categories aggregate the payor types by nature, amount, timing and uncertainty of its revenue streams. Disaggregated revenue by payor type and major service line for the three months ended March 31, 2019 was as follows (in thousands):
|  | Three Months Ended March 31, |
|  | 2019 |  |  | 2018 |
Commercial Payors |  | $ | 24,347 |  |  | $ | 13,491 |
Centers for Medicare & Medicaid |  |  | 12,746 |  |  |  | 8,432 |
Healthcare Institutions |  |  | 10,121 |  |  |  | 8,642 |
Total |  | $ | 47,214 |  |  | $ | 30,565 |

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