Note C — Revenue Recognition

Patient Care Segment

Revenue in our Patient Care segment is primarily derived from contracts with third party payors for the provision of O&P devices and is recognized upon the transfer of control of promised products or services to the patient at the time the patient receives the device. At, or subsequent to delivery, we issue an invoice to the third party payor, which primarily consists of commercial insurance companies, Medicare, Medicaid, the U.S. Department of Veterans Affairs, and private or patient pay (“Private Pay”) individuals. We recognize revenue for the amounts we expect to receive from payors based on expected contractual reimbursement rates, which are net of estimated contractual discounts and implicit price concessions. These revenue amounts are further revised as claims are adjudicated, which may result in additional disallowances.

The following table disaggregates revenue from contracts with customers in our Patient Care segment for the three and nine months ended September 30, 2019 and 2018:


	For the Three Months Ended				For the Nine Months Ended
	September 30,				September 30,
(in thousands)	2019		2018		2019		2018
Patient Care Segment
Medicare	$	72,879	$	69,724	$	206,295	$	197,461
Medicaid		36,140		33,597		103,631		96,993
Commercial Insurance/ Managed Care (excluding Medicare and Medicaid Managed Care)		83,384		78,333		232,410		226,761
Veterans Administration		23,816		19,317		64,635		56,873
Private Pay		14,712		13,109		45,729		42,657
Total	$	230,931	$	214,080	$	652,700	$	620,745

The impact to revenue related to prior period performance obligations was not material for the three and nine months ended September 30, 2019.

Products & Services Segment

Revenue in our Products & Services segment is derived from the distribution of O&P components and the leasing and sale of rehabilitation equipment and ancillary consumable supplies combined with equipment maintenance, education, and training.

The following table disaggregates revenue from contracts with customers in our Product & Services segment for the three and nine months ended September 30, 2019 and 2018:


	For the Three Months Ended				For the Nine Months Ended
	September 30,				September 30,
(in thousands)	2019		2018		2019		2018
Products & Services Segment
Distribution services, net of intersegment revenue eliminations	$	36,653	$	34,666	$	107,510	$	100,700
Therapeutic solutions		12,054		14,200		36,945		42,462
Total	$	48,707	$	48,866	$	144,455	$	143,162