v3.26.3
Revenue Recognition Revenue Recognition
 9 Months Ended
Sep. 30, 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 September 30, 2026Three months ended September 30, 2025
U.S. dialysisOther — Ancillary servicesConsolidatedU.S. dialysisOther — Ancillary servicesConsolidated
Dialysis patient service revenues:
Medicare and Medicare Advantage$1,756,098 $$1,756,098 $1,715,224 $$1,715,224 
Medicaid and Managed Medicaid228,173 228,173 214,658 214,658 
Other government89,887 252,760 342,647 86,996 237,627 324,623 
Commercial969,474 133,882 1,103,356 956,887 98,630 1,055,517 
Other revenues:
Medicare and Medicare Advantage137,027 137,027 85,877 85,877 
Commercial4,265 4,265 3,762 3,762 
Other(1)
6,846 23,832 30,678 6,275 28,994 35,269 
Eliminations of intersegment revenues(22,008)(2,110)(24,118)(11,932)(2,771)(14,703)
Total$3,028,470 $549,656 $3,578,126 $2,968,108 $452,119 $3,420,227 
Nine months ended September 30, 2026Nine months ended September 30, 2025
U.S. dialysisOther — Ancillary servicesConsolidatedU.S. dialysisOther — Ancillary servicesConsolidated
Dialysis patient service revenues:
Medicare and Medicare Advantage$5,180,801 $$5,180,801 $4,983,850 $$4,983,850 
Medicaid and Managed Medicaid667,947 667,947 638,865 638,865 
Other government271,675 737,316 1,008,991 246,846 672,928 919,774 
Commercial2,863,944 379,598 3,243,542 2,828,790 277,057 3,105,847 
Other revenues:
Medicare and Medicare Advantage397,776 397,776 324,981 324,981 
Medicaid and Managed Medicaid— — 2 2 
Commercial14,153 14,153 14,786 14,786 
Other(1)
19,636 77,238 96,874 18,248 65,647 83,895 
Eliminations of intersegment revenues(53,841)(8,485)(62,326)(40,382)(8,336)(48,718)
Total$8,950,162 $1,597,596 $10,547,758 $8,676,217 $1,347,065 $10,023,282 
(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 $137,520 and $103,741 during the nine months ended September 30, 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 $386,724 and $310,541 as of September 30, 2026 and December 31, 2025, respectively.