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Accounts Receivable and Net Revenue | 9 Months Ended
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Sep. 30, 2019
Text Block [Abstract] |
Accounts Receivable and Net Revenue |
4. | Accounts Receivable and Net Revenue:
Accounts receivable, net consists of the following (in thousands):
|  | September 30, 2019 |  |  | December 31, 2018 |
Gross accounts receivable |  | $ | 1,923,585 |  |  | $ | 1,993,395 |
Allowance for contractual adjustments and uncollectibles |  |  | (1,428,886 | ) |  |  | (1,486,672 | )
|  | $ | 494,699 |  |  | $ | 506,723 |
Patient service revenue is recognized at the time services are provided by the Company’s affiliated physicians. The Company’s performance obligations related to the delivery of services to patients are satisfied at the time of service. Accordingly, there are no performance obligations that are unsatisfied or partially unsatisfied at the end of the reporting period with respect to patient service revenue. Almost all of the Company’s patient service revenue is reimbursed by government-sponsored healthcare programs (“GHC Programs”) and third-party insurance payors. Payments for services rendered to the Company’s patients are generally less than billed charges. The Company monitors its revenue and receivables from these sources and records an estimated contractual allowance to properly account for the anticipated differences between billed and reimbursed amounts. Accordingly, patient service revenue is presented net of an estimated provision for contractual adjustments and uncollectibles. The Company estimates allowances for contractual adjustments and uncollectibles on accounts receivable based upon historical experience and other factors, including days sales outstanding (“DSO”) for accounts receivable, evaluation of expected adjustments and delinquency rates, past adjustments and collection experience in relation to amounts billed, an aging of accounts receivable, current contract and reimbursement terms, changes in payor mix and other relevant information. Contractual adjustments result from the difference between the physician rates for services performed and the reimbursements by GHC Programs and third-party insurance payors for such services. Collection of patient service revenue the Company expects to receive is normally a function of providing complete and correct billing information to the GHC Programs and third-party insurance payors within the various filing deadlines and typically occurs within 30 to 60 days of billing. Some of the Company’s hospital agreements require hospitals to pay the Company administrative fees. Some agreements provide for fees if the hospital does not generate sufficient patient volume in order to guarantee that the Company receives a specified minimum revenue level. The Company also receives fees from hospitals for administrative services performed by its affiliated physicians providing medical director or other services at the hospital. The following table summarizes the Company’s net revenue by category (in thousands):
|  | Three Months Ended September 30, |  |  | Nine Months Ended September 30, |
|  | 2019 |  |  | 2018 |  |  | 2019 |  |  | 2018 |
Net patient service revenue |  | $ | 784,935 |  |  | $ | 758,015 |  |  | $ | 2,300,045 |  |  | $ | 2,278,055 |
Hospital contract administrative fees |  |  | 97,747 |  |  |  | 87,095 |  |  |  | 289,209 |  |  |  | 273,868 |
Other revenue |  |  | 5,993 |  |  |  | 3,649 |  |  |  | 18,913 |  |  |  | 14,451 |
|  | $ | 888,675 |  |  | $ | 848,759 |  |  | $ | 2,608,167 |  |  | $ | 2,566,374 |
The approximate percentage of net patient service revenue by type of payor was as follows:
|  | Three Months Ended September 30, |  |  | Nine Months Ended September 30, |
|  | 2019 |  |  | 2018 |  |  | 2019 |  |  | 2018 |
Contracted managed care |  |  | 69 | % |  |  | 70 | % |  |  | 69 | % |  |  | 70 | %
Government |  |  | 25 |  |  |  | 24 |  |  |  | 24 |  |  |  | 24 |
Other third-parties |  |  | 4 |  |  |  | 5 |  |  |  | 5 |  |  |  | 5 |
Private-pay patients |  |  | 2 |  |  |  | 1 |  |  |  | 2 |  |  |  | 1 |
|  |  | 100 | % |  |  | 100 | % |  |  | 100 | % |  |  | 100 | %

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