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Revenue
 3 Months Ended
Mar. 31, 2021
Revenue From Contract With Customer [Abstract]  
Revenue

4.

Revenue

Revenue is primarily derived from services rendered to patients for inpatient psychiatric and substance abuse care, outpatient psychiatric care and residential treatment. The services provided by the Company have no fixed duration and can be terminated by the patient or the facility at any time, and therefore, each treatment is its own stand-alone contract.

As our performance obligations relate to contracts with a duration of one year or less, the Company elected the optional exemption in Accounting Standards Codification (“ASC”) ASC 606-10-50-14(a). Therefore, the Company is not required to disclose the transaction price for the remaining performance obligations at the end of the reporting period or when the Company expects to recognize the revenue. The Company has minimal unsatisfied performance obligations at the end of the reporting period as our patients typically are under no obligation to remain admitted in our facilities.

The Company disaggregates revenue from contracts with customers by service type and by payor.

The Company’s facilities in the United States (the “U.S. Facilities”) and services provided by the facilities can generally be classified into the following categories: acute inpatient psychiatric facilities; specialty treatment facilities; residential treatment centers; and outpatient community-based facilities.

Acute inpatient psychiatric facilities. Acute inpatient psychiatric facilities provide a high level of care in order to stabilize patients that are either a threat to themselves or to others. The acute setting provides 24-hour observation, daily intervention and monitoring by psychiatrists.

Specialty treatment facilities. Specialty treatment facilities include residential recovery facilities, eating disorder facilities and comprehensive treatment centers. The Company provides a comprehensive continuum of care for adults with addictive disorders and co-occurring mental disorders. Inpatient, including detoxification and rehabilitation, partial hospitalization and outpatient treatment programs give patients access to the least restrictive level of care.

Residential treatment centers. Residential treatment centers treat patients with behavioral disorders in a non-hospital setting, including outdoor programs. The facilities balance therapy activities with social, academic and other activities.

Outpatient community-based facilities. Outpatient community-based programs are designed to provide therapeutic treatment to children and adolescents who have a clinically-defined emotional, psychiatric or chemical dependency disorder while enabling the youth to remain at home and within their community.

The table below presents total revenue attributed to each category (in thousands):

 

 

 

Three Months Ended

March 31,

 

 

 

2021

 

 

2020

 

Acute inpatient psychiatric facilities

 

$

267,359

 

 

$

239,414

 

Specialty treatment facilities

 

 

211,757

 

 

 

193,611

 

Residential treatment centers

 

 

68,649

 

 

 

70,434

 

Outpatient community-based facilities

 

 

3,434

 

 

 

5,758

 

Revenue

 

$

551,199

 

 

$

509,217

 

The Company receives payments from the following sources for services rendered in our facilities: (i) state governments under their respective Medicaid and other programs; (ii) commercial insurers; (iii) the federal government under the Medicare program administered by CMS; and (iv) individual patients and clients.

The Company determines the transaction price based on established billing rates reduced by contractual adjustments provided to third-party payors, discounts provided to uninsured patients and implicit price concessions. Contractual adjustments and discounts are based on contractual agreements, discount policies and historical experience. Implicit price concessions are based on historical collection experience. Most of our facilities have contracts containing variable consideration. However, it is unlikely a significant reversal of revenue will occur when the uncertainty is resolved, and therefore, the Company has included the variable consideration in the estimated transaction price. Subsequent changes resulting from a patient’s ability to pay are recorded as bad debt expense, which is included as a component of other operating expenses in the condensed consolidated statements of operations. Bad debt expense for the three months ended March 31, 2021 and 2020 was not significant.

The following table presents the Company’s revenue by payor type and as a percentage of revenue (in thousands):

 

 

Three Months Ended

March 31,

 

 

 

2021

 

 

2020

 

 

 

Amount

 

 

%

 

 

Amount

 

 

%

 

Commercial

 

$

162,702

 

 

 

29.5

%

 

$

143,142

 

 

 

28.1

%

Medicare

 

 

86,185

 

 

 

15.6

%

 

 

72,271

 

 

 

14.2

%

Medicaid

 

 

274,620

 

 

 

49.8

%

 

 

260,044

 

 

 

51.1

%

Self-Pay

 

 

22,443

 

 

 

4.1

%

 

 

27,034

 

 

 

5.3

%

Other

 

 

5,249

 

 

 

1.0

%

 

 

6,726

 

 

 

1.3

%

Revenue

 

$

551,199

 

 

 

100.0

%

 

$

509,217

 

 

 

100.0

%

Contract liabilities primarily consisted of unearned revenue from CMS’ Accelerated and Advance Payment Program. In April 2020, the Company received approximately $45 million from CMS’ Accelerated and Advance Payment Program for Medicare providers, which the Company expects to repay over the 12-month period beginning in April 2021. Once repayment begins, the amount will be recouped from the Company’s new Medicare claims. Contract liabilities are included in other accrued liabilities for the three months ended March 31, 2021 and, for December 31, 2020, $35.9 million is included in other accrued liabilities and $11.3 million in other liabilities on the condensed consolidated balance sheets. A summary of the activity in unearned revenue is as follows (in thousands):

Balance at December 31, 2020

 

$

47,196

 

Payments received

 

 

2,436

 

Revenue recognized

 

 

(478

)

Balance at March 31, 2021

 

$

49,154