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Summary of Significant Accounting Policies (Tables) | 12 Months Ended
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Dec. 31, 2020
Accounting Policies [Abstract] |
Schedule of Changes in Allowance for Doubtful Accounts | The following table presents the changes in the allowance for doubtful accounts (in thousands):
| Year ended December 31,
| 2020 |  | 2019 |  | 2018
Balance, beginning of year | $ | 9,049 |  |  | $ | 7,296 |  |  | $ | 4,486 |
Add: adoption of ASC 326 | 461 |  |  | — |  |  | — |
Add: provision for doubtful accounts | 10,515 |  |  | 9,129 |  |  | 7,353 |
Less: write-offs, net of recoveries and other adjustments | (7,314) |  |  | (7,376) |  |  | (4,543) |
Balance, end of year | $ | 12,711 |  |  | $ | 9,049 |  |  | $ | 7,296 |
Schedule of Changes in Contractual Allowance | The following table presents the changes in the contractual allowance (in thousands):
| Year ended December 31,
| 2020 |  | 2019 |  | 2018
Balance, beginning of year | $ | 15,433 |  |  | $ | 9,205 |  |  | $ | 6,345 |
Add: allowance for contractual adjustments | 20,916 |  |  | 15,518 |  |  | 9,095 |
Less: contractual adjustments | (15,068) |  |  | (9,290) |  |  | (6,235) |
Balance, end of year | $ | 21,281 |  |  | $ | 15,433 |  |  | $ | 9,205 |
Disaggregated Revenue by Payor Type and Major Service Line | 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 years ended December 31, 2020 and December 31, 2019 were as follows (in thousands):
| Year Ended December 31,
| 2020 |  | 2019 |  | 2018
Contracted third-party payors | $ | 135,939 |  |  | $ | 101,845 |  |  | $ | 56,949 |
Non-contracted third-party payors | 15,295 |  |  | 10,770 |  |  | 12,447 |
Centers for Medicare & Medicaid | 72,536 |  |  | 58,918 |  |  | 40,482 |
Healthcare institutions | 41,396 |  |  | 43,019 |  |  | 37,399 |
Total | $ | 265,166 |  |  | $ | 214,552 |  |  | $ | 147,277 |
Schedule of Impact of Adoption of ASU 2014-09 on Financial Statements | The following table presents the impact of adoption of ASU 2014-09 on the Consolidated Statement of Operations and the Consolidated Balance Sheet (in thousands):
| Year Ended December 31, 2018
Consolidated Statement of Operations Impact: | As Reported |  | Without the adoption of Topic 606 |  | Impact
Revenue | $ | 147,293 |  |  | $ | 145,320 |  |  | $ | 1,973 |
Sales, General & Administrative Expense | $ | 131,582 |  |  | $ | 132,603 |  |  | $ | (1,021) |
Net Loss | $ | (48,280) |  |  | $ | (51,274) |  |  | $ | 2,994 |
| Year Ended December 31, 2018
Consolidated Balance Sheet Impact: | As Reported |  | Without the adoption of Topic 606 |  | Impact
Accounts Receivable, net | $ | 21,977 |  |  | $ | 17,629 |  |  | $ | 4,348 |
Accumulated Deficit | $ | (203,515) |  |  | $ | (207,863) |  |  | $ | 4,348 |

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