v3.26.1
Revenue Recognition Revenue Recognition
 3 Months Ended
Mar. 31, 2026
Text Block [Abstract]  
Revenue Recognition [Text Block] Revenue recognition
The following tables summarize the Company's segment revenues by primary payor source:
Three months ended March 31, 2026Three months ended March 31, 2025
U.S. dialysisOther — Ancillary servicesConsolidatedU.S. dialysisOther — Ancillary servicesConsolidated
Dialysis patient service revenues:
Medicare and Medicare Advantage$1,675,413 $$1,675,413 $1,609,018 $$1,609,018 
Medicaid and Managed Medicaid212,830 212,830 206,509 206,509 
Other government92,940 248,179 341,119 76,746 209,747 286,493 
Commercial954,243 109,664 1,063,907 924,888 87,819 1,012,707 
Other revenues:
Medicare and Medicare Advantage108,506 108,506 98,954 98,954 
Medicaid and Managed Medicaid— — 2 2 
Commercial3,648 3,648 2,701 2,701 
Other(1)
6,275 27,610 33,885 6,008 15,599 21,607 
Eliminations of intersegment revenues(20,472)(3,288)(23,760)(11,734)(2,728)(14,462)
Total$2,921,229 $494,319 $3,415,548 $2,811,435 $412,094 $3,223,529 
(1)    Consists primarily of management service fees in the Company's U.S. dialysis business and research fees, management fees, and other non-patient service revenues in the Other - ancillary services businesses.
There are significant uncertainties associated with estimating revenue, many of which take several years to resolve. These estimates are subject to ongoing insurance coverage changes, geographic coverage differences, differing interpretations of contract coverage and other payor issues, as well as patient issues, including determination of applicable primary and secondary coverage, changes in patient insurance coverage and coordination of benefits. As these estimates are refined over time, both positive and negative adjustments to revenue are recognized in the current period.
Measurements of revenue for the Company's integrated kidney care (IKC) risk-based arrangements are complex, sensitive to a number of key inputs, and require meaningful estimates for a number of factors, including but not limited to member alignment data, third-party medical claims expense, outcomes on various quality metrics, and ultimate risk adjustment factor scores. Information and other measurement limitations on these factors may constrain revenue recognition for a risk-based arrangement until a period after the Company's performance obligations have been met. For its IKC business, the Company recognized revenues for performance obligations satisfied in previous years of $35,477 and $28,463 during the three months ended March 31, 2026 and 2025, respectively. The delay in recognition of these amounts resulted predominantly from measurement limitations and recognition constraints on the Company's value-based care contracts with health plans, many of
which are complex. Recognition of revenue from the Company's government Comprehensive Kidney Care Contracting program also has certain constraints for plan years 2025 and 2026.
Customer contract assets. The carrying value of customer contract assets, which are included in contract assets and other receivables and other long-term assets on the Company’s consolidated balance sheet, was $354,329 and $310,541 as of March 31, 2026 and December 31, 2025, respectively.