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Accounts Receivable, Net
 12 Months Ended
Dec. 31, 2021
Accounts Receivable, after Allowance for Credit Loss [Abstract]  
Accounts Receivable, Net Accounts Receivable, Net
Accounts receivable, net represents outstanding amounts we expect to collect from the transfer of our products and services.  Principally, these amounts are comprised of receivables from Medicare, Medicaid, and commercial insurance plans.  Our accounts receivable represent amounts outstanding from our gross charges, net of contractual discounts, sales returns, and other implicit price concessions including estimates for payor disallowances and patient non-payments.
We are exposed to credit losses primarily through our accounts receivable. These receivables are short in nature because their due date varies between due upon receipt of invoice and 90 days. We assess our receivables, divide them into similar risk pools, and monitor our ongoing credit exposure through active review of our aging buckets. Our activities include timely account reconciliations, dispute resolution, and payment confirmations. We also employ collection agencies and legal counsel to pursue recovery of defaulted receivables.
Our expected loss methodology is developed using historical liquidation rates, current and future economic and market conditions, and a review of the current status of our patients and customers’ trade accounts receivable balances. We also grouped our receivables into similar risk pools to better measure the risks for each pool. After evaluating the risk for each pool, we determined that additional credit loss risk was immaterial for the Patient Care segment. For the Products & Services segment, an allowance for doubtful accounts is recorded, which is deducted from gross accounts receivable to arrive at “Accounts receivable, net.” As of December 31, 2021, we have considered the current and future economic and market conditions resulting in a decrease to the allowance for doubtful accounts by approximately $0.8 million since December 31, 2020.
Accounts receivable, net as of December 31, 2021 and 2020 is comprised of the following:
As of December 31, 2021As of December 31, 2020
(in thousands)Patient CareProducts & ServicesConsolidatedPatient CareProducts & ServicesConsolidated
Gross charges before estimates for implicit price concessions$173,115 $21,459 $194,574 $156,504 $21,300 $177,804 
Less estimates for implicit price concessions:
Payor disallowances(33,007)— (33,007)(39,343)— (39,343)
Patient non-payments(7,500)— (7,500)(7,042)— (7,042)
Accounts receivable, gross132,608 21,459 154,067 110,119 21,300 131,419 
Allowance for doubtful accounts— (2,009)(2,009)— (2,823)(2,823)
Accounts receivable, net$132,608 $19,450 $152,058 $110,119 $18,477 $128,596 
Approximately 46.3% and 46.8% of gross charges before estimates for payor disallowances and patient non-payments, is due from the Federal Government (Medicare, Medicaid, and the VA) at December 31, 2021 and 2020, respectively.
The following table summarizes activities by year for the allowance for doubtful accounts:
(in thousands)Allowance for Doubtful Accounts
Balance at December 31, 2018$2,272 
Additions1,877 
Reductions(762)
Recoveries(746)
Balance at December 31, 20192,641 
Additions 1,869 
Reductions(114)
Recoveries(1,573)
Balance at December 31, 20202,823 
Additions 907 
Reductions(759)
Recoveries(962)
Balance at December 31, 2021$2,009 
The following tables represent gross charges before estimates for payor disallowances and patient non-payments, by major payor classification and by aging categories reduced by implicit price concessions and allowance for doubtful accounts to accounts receivable, net as of December 31, 2021 and 2020, respectively:
December 31, 2021
(in thousands)0-60
Days		61-120
Days		121-180
Days		Over 180
Days		Total
Patient Care
Commercial insurance (excluding Medicare and Medicaid Managed Care)$50,397 $12,559 $6,512 $11,869 $81,337 
Private pay938 392 284 121 1,735 
Medicaid15,595 3,404 1,698 4,135 24,832 
VA4,345 868 517 453 6,183 
Non-Medicare71,275 17,223 9,011 16,578 114,087 
Medicare35,354 6,100 3,923 13,651 59,028 
Products & Services accounts receivable, before allowance14,301 5,071 901 1,186 21,459 
Gross charges before estimates for implicit price concessions and allowance for doubtful accounts120,930 28,394 13,835 31,415 194,574 
Less estimates for implicit price concessions(40,507)
Accounts receivable, before allowance154,067 
Allowance for doubtful accounts(2,009)
Accounts receivable, net$152,058 
December 31, 2020
(in thousands)0-60
Days		61-120
Days		121-180
Days		Over 180
Days		Total
Patient Care
Commercial insurance (excluding Medicare and Medicaid Managed Care)$43,069 $10,743 $5,335 $12,316 $71,463 
Private pay850 401 309 281 1,841 
Medicaid13,569 2,705 1,390 3,771 21,435 
VA4,291 692 263 279 5,525 
Non-Medicare61,779 14,541 7,297 16,647 100,264 
Medicare27,572 5,169 2,915 20,585 56,241 
Products & Services accounts receivable, before allowance14,091 4,598 841 1,769 21,299 
Gross charges before estimates for implicit price concessions and allowance for doubtful accounts103,442 24,308 11,053 39,001 177,804 
Less estimates for implicit price concessions(46,385)
Accounts receivable, before allowance131,419 
Allowance for doubtful accounts(2,823)
Accounts receivable, net$128,596