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Accounts Receivable and Net Revenue
 12 Months Ended
Dec. 31, 2017
Receivables [Abstract]  
Accounts Receivable and Net Revenue

4.    Accounts Receivable and Net Revenue:

Accounts receivable, net consists of the following (in thousands):

 

     December 31,  
     2017      2016  

Gross accounts receivable

    $ 1,790,034      $ 1,719,642  

Allowance for contractual adjustments and uncollectibles

      (1,286,035 )       (1,224,366 ) 
  

 

 

     

 

 

  
   $ 503,999      $ 495,276  
  

 

 

     

 

 

  

Net revenue consists of the following (in thousands):

 

    Years Ended December 31,  
    2017     2016     2015  

Gross revenue

   $ 11,427,238     $ 10,374,813     $ 8,942,957  

Contractual adjustments and uncollectibles

     (8,285,317 )      (7,464,030 )      (6,389,195 ) 

Hospital contract administrative fees

     316,391       272,376       226,234  
 

 

 

    

 

 

    

 

 

  
  $ 3,458,312     $ 3,183,159     $ 2,779,996  
 

 

 

    

 

 

    

 

 

  

Accounts receivable of $504.0 million and $495.3 million at December 31, 2017 and 2016, respectively, consist primarily of amounts due from government-sponsored healthcare programs and third-party insurance payors for services provided by the Company’s affiliated physicians.

Net revenue of $3.5 billion, $3.2 billion and $2.8 billion for the years ended December 31, 2017, 2016 and 2015, respectively, consists primarily of gross billed charges for services provided by the Company’s affiliated physicians less an estimated allowance for contractual adjustments and uncollectibles to properly account for the anticipated differences between gross billed charge amounts and expected reimbursement amounts.

The Company’s contractual adjustments and uncollectibles as a percentage of gross patient service revenue vary slightly each year depending on several factors, including improved managed care contracting, changes in reimbursement from state Medicaid programs and other government-sponsored programs, shifts in the percentage of patient services being reimbursed under government-sponsored programs and annual price increases.

The Company’s annual price increases typically increase contractual adjustments as a percentage of gross patient service revenue. This increase is primarily due to Medicaid, Medicare and other government-sponsored healthcare programs that generally provide for reimbursements on a fee-schedule basis rather than on a gross charge basis. When the Company bills these programs, like other payors, on a gross-charge basis, it also increases its provision for contractual adjustments and uncollectibles by the amount of any price increase, resulting in a higher contractual adjustment percentage.