MiMedx (MDXG) 10-Q 6 Jul 20 2020 Q1 Quarterly report Financial data

Cover Page

Cover Page - shares	3 Months Ended
	Mar. 31, 2020	Jun. 25, 2020
Cover [Abstract]
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Mar. 31, 2020
Document Transition Report	false
Entity File Number	001-35887
Entity Registrant Name	MIMEDX GROUP, INC.
Entity Incorporation, State or Country Code	FL
Entity Tax Identification Number	26-2792552
Entity Address, Address Line One	1775 West Oak Commons Ct NE
Entity Address, City or Town	Marietta
Entity Address, State or Province	GA
Entity Address, Postal Zip Code	30062
City Area Code	770
Local Phone Number	651-9100
Entity Current Reporting Status	No
Entity Interactive Data Current	No
Entity Filer Category	Accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	false
Entity Shell Company	false
Entity Common Stock, Shares Outstanding		110,328,875
Entity Central Index Key	0001376339
Current Fiscal Year End Date	--12-31
Document Fiscal Year Focus	2020
Document Fiscal Period Focus	Q1
Amendment Flag	false

CONDENSED CONSOLIDATED BALANCE

CONDENSED CONSOLIDATED BALANCE SHEETS - USD ($) $ in Thousands	Mar. 31, 2020	Dec. 31, 2019
Current assets:
Cash and cash equivalents	$ 53,525	$ 69,069
Accounts receivable, net	31,932	32,327
Inventory, net	9,247	9,104
Prepaid expenses	5,239	6,669
Income tax receivable	10,729	18
Other current assets	5,216	6,058
Total current assets	115,888	123,245
Property and equipment, net	11,833	12,328
Right of use asset	3,158	3,397
Goodwill	19,976	19,976
Intangible assets, net	7,581	7,777
Other assets	473	443
Total assets	158,909	167,166
Current liabilities:
Accounts payable	9,756	8,710
Accrued compensation	17,116	21,302
Accrued expenses	30,661	32,161
Current portion of long term debt	3,750	3,750
Other current liabilities	2,416	1,399
Total current liabilities	63,699	67,322
Long term debt, net	61,637	61,906
Other liabilities	3,234	3,540
Total liabilities	128,570	132,768
Commitments and contingencies (Note 13)
Stockholders' equity:
Preferred stock; $.001 par value; 5,000,000 shares authorized; 0 issued and 0 outstanding at March 31, 2020 and 0 issued and 0 outstanding at December 31, 2019	0	0
Common stock; $.001 par value; 150,000,000 shares authorized; 112,703,926 issued and 110,540,860 outstanding at March 31, 2020 and 112,703,926 issued and 110,818,649 outstanding at December 31, 2019	113	113
Additional paid-in capital	149,765	147,231
Treasury stock at cost; 2,163,066 shares at March 31, 2020 and 1,885,277 shares at December 31, 2019	(12,578)	(10,806)
Accumulated deficit	(106,961)	(102,140)
Total stockholders' equity	30,339	34,398
Total liabilities and stockholders' equity	$ 158,909	$ 167,166

CONDENSED CONSOLIDATED BALANC_2

CONDENSED CONSOLIDATED BALANCE SHEETS (Parenthetical) - $ / shares	Mar. 31, 2020	Dec. 31, 2019
Stockholders' equity:
Preferred stock par value (in dollars per share)	$ 0.001	$ 0.001
Preferred stock, shares authorized (in shares)	5,000,000	5,000,000
Preferred stock, shares issued (in shares)	0	0
Preferred stock, shares outstanding (in shares)	0	0
Common stock, par value (in dollars per share)	$ 0.001	$ 0.001
Common stock, shares authorized (in shares)	150,000,000	150,000,000
Common stock, shares issued (in shares)	112,703,926	112,703,926
Common stock, shares outstanding (in shares)	110,540,860	110,818,649
Treasury stock, shares (in shares)	2,163,066	1,885,277

CONDENSED CONSOLIDATED STATEMEN

CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019
Income Statement [Abstract]
Net sales	$ 61,736	$ 66,555
Cost of sales	10,025	7,418
Gross profit	51,711	59,137
Operating expenses:
Selling, general and administrative	46,942	50,862
Investigation, restatement and related	15,592	18,107
Research and development	2,650	2,902
Amortization of intangible assets	271	233
Impairment of intangible asset	0	446
Operating loss	(13,744)	(13,413)
Other income (expense), net
Interest (expense) income, net	(2,387)	211
Other income (expense), net	6	(29)
Loss before income tax provision	(16,125)	(13,231)
Income tax provision benefit (expense)	11,304	(42)
Net loss	$ (4,821)	$ (13,273)
Net loss per common share - basic (in dollars per share)	$ (0.04)	$ (0.12)
Net loss per common share - diluted (in dollars per share)	$ (0.04)	$ (0.12)
Weighted average shares outstanding - basic (in shares)	107,538,509	106,420,317
Weighted average shares outstanding - diluted (in shares)	107,538,509	106,420,317

CONDENSED CONSOLIDATED STATEM_2

CONDENSED CONSOLIDATED STATEMENTS OF STOCKHOLDERS' EQUITY - USD ($) $ in Thousands	Total	Common Stock Issued	Additional Paid-in Capital	Treasury Stock	Accumulated Deficit
Balance (in shares) at Dec. 31, 2018		112,703,926		3,605,263
Balance, beginning of period at Dec. 31, 2018	$ 49,655	$ 113	$ 164,744	$ (38,642)	$ (76,560)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Share-based compensation expense	3,014		3,014
Issuance of restricted stock (in shares)				(251,305)
Issuance of restricted stock	0		(3,025)	$ 3,025
Restricted stock shares canceled/forfeited	0		1,563	$ (1,563)
Restricted stock shares cancelled/forfeited (in shares)				141,381
Shares repurchased for tax withholding (in shares)				336,674
Shares repurchased for tax withholding	(1,044)			$ (1,044)
Net loss	(13,273)				(13,273)
Balance (in shares) at Mar. 31, 2019		112,703,926		3,832,013
Balance, end of period at Mar. 31, 2019	38,352	$ 113	166,296	$ (38,224)	(89,833)
Balance (in shares) at Dec. 31, 2019		112,703,926		1,885,277
Balance, beginning of period at Dec. 31, 2019	34,398	$ 113	147,231	$ (10,806)	(102,140)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Share-based compensation expense	1,915		1,915
Exercise of stock options (in shares)				(170,300)
Exercise of stock options	298		(1,214)	$ 1,512
Restricted stock shares canceled/forfeited	0		1,746	$ (1,746)
Restricted stock shares cancelled/forfeited (in shares)				242,998
Shares repurchased for tax withholding (in shares)				205,091
Shares repurchased for tax withholding	(1,451)		87	$ (1,538)
Net loss	(4,821)				(4,821)
Balance (in shares) at Mar. 31, 2020		112,703,926		2,163,066
Balance, end of period at Mar. 31, 2020	$ 30,339	$ 113	$ 149,765	$ (12,578)	$ (106,961)

CONDENSED CONSOLIDATED STATEM_3

CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019
Cash flows from operating activities:
Net loss	$ (4,821)	$ (13,273)
Adjustments to reconcile net income to net cash from operating activities:
Share-based compensation	3,349	3,014
Depreciation	1,506	1,695
Amortization of intangible assets	271	233
Amortization of deferred financing costs and debt discount	668	0
Non-cash lease expenses	239	269
Loss on fixed asset disposal	0	1
Impairment of intangible assets	0	1,258
Increase (decrease) in cash resulting from changes in:
Accounts receivable	395	0
Inventory	(143)	(442)
Prepaid expenses	1,430	2,053
Income tax receivable	(10,711)	(12)
Other assets	812	(1,612)
Accounts payable	1,046	(4,173)
Accrued compensation	(4,186)	(7,501)
Accrued expenses	(2,845)	3,895
Income taxes	0	0
Other liabilities	709	(665)
Cash flows used in operating activities	(12,281)	(15,260)
Cash flows from investing activities:
Purchases of equipment	(1,011)	(648)
Principal payments from note receivable	0	389
Patent application costs	(75)	(174)
Cash flows used in investing activities	(1,086)	(433)
Cash flows from financing activities:
Proceeds from exercise of stock options	298	0
Stock repurchased for tax withholdings on vesting of restricted stock	(1,538)	(1,044)
Repayment of term loan	(937)	0
Cash flows used in financing activities	(2,177)	(1,044)
Net change in cash	(15,544)	(16,737)
Cash and cash equivalents, beginning of period	69,069	45,118
Cash and cash equivalents, end of period	$ 53,525	$ 28,381

Nature of Business

Nature of Business	3 Months Ended
	Mar. 31, 2020
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Nature of Business	Nature of Business MiMedx Group, Inc. (together with its subsidiaries except where the context otherwise requires “ MiMedx ,” or the “ Company ”) is an advanced wound care and emerging therapeutic biologics company, developing and distributing human placental tissue allografts with patent-protected processes for multiple sectors of healthcare. The Company derives its products from human placental tissues processed using proprietary processing methodologies. The Company’s mission is to offer physicians products and tissues to help the body heal itself. MiMedx provides products in the wound care, burn, surgical, orthopedic, spine, sports medicine, ophthalmic and dental sectors of healthcare. All of the Company’s products are regulated by the United States Food and Drug Administration (“ FDA ”). MiMedx is the leading supplier of human placental allografts, which are human tissues that are transplanted from one person (a donor) to another person (a recipient). The Company operates in one business segment, Regenerative Biomaterials, which includes the design, manufacture, and marketing of products for the wound care, burn, surgical, orthopedic, spine, sports medicine, ophthalmic and dental sectors of healthcare. The Company’s allograft product families include: the dHACM family with AmnioFix® and EpiFix® brands; the Umbilical family with EpiCord® and AmnioCord® brands; and the Placental Collagen family with AmnioFill™ brands. AmnioFix and EpiFix are tissue allografts derived from amnion and chorion layers of human placental membrane; EpiCord and AmnioCord are tissue allografts derived from umbilical cord tissue. AmnioFill is a placental connective tissue matrix, derived from the placental disc and other placental tissue. The Company’s business model is focused primarily on the United States of America but the Company is exploring potential future international expansion opportunities. Effect of COVID-19 Pandemic The COVID-19 pandemic and governmental and societal responses thereto have affected the Company’s business, results of operations and financial condition. The continuation or additional waves of the outbreak of COVID-19 or the outbreak of other health epidemics could harm the Company’s operations and increase the Company’s costs and expenses in numerous ways. The ultimate impact of the COVID-19 pandemic is highly uncertain and subject to change. The Company does not yet know the full extent of delays or impacts on the business, clinical trials, healthcare systems or the global economy as a whole, or how long such effects will endure. The effects of the COVID-19 pandemic or other health epidemics could have an adverse impact on the Company’s business, results of operations and financial condition. On March 27, 2020, the Coronavirus Aid, Relief and Economic Security Act (the “ CARES Act ”) was signed into law. The CARES Act includes provisions relating to refundable payroll tax credits, deferment of the employer portion of certain payroll taxes, loans and grants to certain business, net operating loss carryback periods, alternative minimum tax credit refunds, modifications to the net interest deduction limitations and technical corrections to tax depreciation methods for qualified improvement property. As a result of the CARES Act, the Company expects a federal tax refund of approximately $11.3 million and has recognized an income tax benefit of the same amount.

Significant Accounting Policies

Significant Accounting Policies	3 Months Ended
	Mar. 31, 2020
Accounting Policies [Abstract]
Significant Accounting Policies	Significant Accounting Policies Please see Note 3 to the Company’s Consolidated Financial Statements included in the Company’s Form 10-K for the fiscal year ended December 31, 2019 (the “ 2019 Form 10-K ”), filed with the Securities and Exchange Commission (“ SEC ”) on July 6, 2020 for a description of all significant accounting policies. Basis of Presentation The unaudited condensed consolidated financial statements have been prepared in accordance with accounting principles generally accepted in the United States of America (“ GAAP ”) from interim financial information and with the instructions to Form 10-Q and Article 10 of Regulation S-X. Accordingly, they do not include all of the information and footnotes required by GAAP for complete financial statements. Changes to GAAP are established by the Financial Accounting Standards Board (“ FASB ”) in the form of Accounting Standards Updates (“ ASU ’’) to the FASB’s Accounting Standards Codification (“ ASC ”). In the opinion of management, all adjustments (consisting of normal recurring accruals) considered necessary for a fair presentation of the results of operations for the periods presented have been included. Operating results for the three months ended March 31, 2020 and 2019 , are not necessarily indicative of the results that may be expected for the fiscal year. The balance sheet at December 31, 2019 , has been derived from the audited consolidated financial statements at that date, but does not include all of the information and footnotes required by GAAP for complete financial statements. You should read these condensed consolidated financial statements together with the historical consolidated financial statements of the Company for the year ended December 31, 2019 , included in the 2019 Form 10-K. Use of Estimates The consolidated financial statements have been prepared in accordance with GAAP. Conformity with GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the consolidated financial statements and the reported consolidated statements of operations during the reporting period. Actual results could differ from those estimates. Significant estimates include estimated useful lives and potential impairment of property and equipment and intangible assets, estimates for contingent liabilities, management’s assessment of the Company’s ability to continue as a going concern, estimates of fair value of share-based payments and valuation of deferred tax assets. Principles of Consolidation The consolidated financial statements include the accounts of MiMedx Group, Inc. and its wholly-owned subsidiaries. All intercompany balances and transactions have been eliminated upon consolidation. Cash and Cash Equivalents Cash and cash equivalents include cash and Federal Deposit Insurance Corporation (“ FDIC ”) insured certificates of deposit held at various banks with an original maturity of three months or less. Accounts Receivable Accounts receivable represent amounts due from customers for which revenue has been recognized. Generally, the Company does not require collateral or any other security to support its receivables. The allowance for doubtful accounts is the Company’s best estimate of the amount of probable credit losses in the Company’s existing receivables. The Company determines the allowance based on factors such as historical collection experience, customers’ current creditworthiness, customer concentrations, age of accounts receivable and general economic conditions that may affect customers’ ability to pay. Notes Receivable Notes receivable represent formal payment agreements with customers which generally arise in situations where amounts shipped and billed have aged significantly as well as the promissory note issued by Stability Biologics, LLC (“ Stability ”) as part of the divestiture of Stability in 2017. The promissory note from Stability was paid in full in the three months ended September 30, 2019. The Company’s notes receivable are included in other current and long-term assets in the accompanying condensed consolidated balance sheets and were valued taking into consideration cost of the market participant inputs, market conditions, liquidity, operating results and other qualitative factors. Inventories Inventories are valued at the lower of cost or net realizable value, using the first-in, first-out (“ FIFO ”) method. Inventory is tracked through raw material, work-in-process, and finished good stages as the product progresses through various production steps and stocking locations. Labor and overhead costs are absorbed through the various production processes until the work order closes. Historical yields and normal capacities are utilized in the calculation of production overhead rates. Reserves for inventory obsolescence are utilized to account for slow-moving inventory as well as inventory no longer needed due to diminished market demand. Revenue Recognition The Company sells its products primarily to individual customers and independent distributors (collectively referred to as “ customers ”). During the three months ended March 31, 2019, the Company’s control environment was such that it created uncertainty surrounding all of its customer arrangements, which required consideration related to the proper revenue recognition under the applicable literature. The control environment allowed for the existence of extra-contractual or undocumented terms or arrangements initiated by or agreed to by the Company and former members of Company management at the outset of the transactions (side agreements). Concessions were also agreed to subsequent to the initial sale (e.g. sales above established customer credit limits extended and unusually long payment terms, return or exchange rights, and contingent payment obligations) that called into question the ability to recognize revenue at the time that product was shipped to a customer. The applicable revenue recognition guidance also changed beginning January 1, 2018, which further impacted the Company’s revenue recognition methodology. As a result, the Company’s application of the applicable revenue recognition guidance varies for the three months ended March 31, 2020 and 2019. Additionally, the Company changed its pattern of revenue recognition effective October 1, 2019. The application of the relevant revenue recognition guidance and the pattern of revenue recognition are further discussed below for each period presented. Three Months Ended March 31, 2019 The Company follows ASC Topic 606, Revenue from Contracts with Customers (“ ASC 606” ) which establishes principles for reporting information about the nature, amount, timing and uncertainty of revenue and cash flows arising from the entity’s contracts to provide goods or services to customers. The core principle requires an entity to recognize revenue to depict the transfer of goods or services to customers in an amount that reflects the consideration that it expects to be entitled to receive in exchange for those goods or services recognized as performance obligations are satisfied. ASC 606 establishes a five-step model for revenue recognition. The first of these steps requires the identification of the contract as described in ASC 606-10-25-1. The specific criteria (the “ Step 1 Criteria ”) to this determination are as follows: • The parties to the contract have approved the contract (in writing, orally, or in accordance with other customary business practices) and are committed to perform their respective obligations; • The entity can identify each party’s rights regarding the goods or services to be transferred; and • The entity can identify the payment terms for the goods or services to be transferred. • The contract has commercial substance. • It is probable that the entity will collect substantially all of the consideration to which it will be entitled in exchange for the goods or services that will be transferred to the customer. For the three months ended March 31, 2019, the Company concluded that the first three of the above criteria were not met upon shipment of product to the customer, the fourth criterion had been met, and the Company acknowledges that there is a degree of uncertainty as to whether the last criterion above had been met. Although the parties to the contract may have approved the contract and purchase orders in writing, the Company concluded that upon shipment of products to the customer there is not sufficient evidence that its customers were committed to perform their obligations defined in the contract due to the existence of extra-contractual or undocumented terms or arrangements (e.g., regarding payment terms, right of return, etc.). The Company’s inability to fulfill these criteria was due to uncertainties of contractual adjustments with customers created by a combination of an inappropriate tone at the top and extra-contractual arrangements. Consequently, the Company concluded that it did not meet the Step 1 Criteria upon shipment of the product. Subsequent to the shipment of product, uncertainties surrounding contractual adjustment were not resolved until either: (1) the customer returned the product prior to payment; or (2) the Company received payment from the customer. At that point, the Company determined that an accounting contract existed and the performance obligations of the Company to deliver product and the customer to pay for the product were satisfied. The Company determined the transaction price of its contracts to equal the amount of consideration received from customers less the amount expected to be refunded or credited to customers, which is recognized as a refund liability that is updated at the end of each reporting period for changes in circumstances. The refund liability is included within accrued expenses in the consolidated balance sheet. Transition and the Three Months Ended March 31, 2020 The Company continued to assess contracts, new and existing, throughout 2019 to determine if the Step 1 Criteria noted above for the determination of a contract under ASC 606 were met for new contracts at the outset of a sales transaction (i.e., upon shipment of product) or for existing contracts at some point within 2019 when all the terms of the arrangement would have been known. Until the Step 1 Criteria had been met, revenue recognition continued to be deferred consistent with the assessment for the year ended December 31, 2018. As further discussed above, the primary factors contributing to the determination in prior periods that the Step 1 Criteria had not been met were the inappropriate tone at the top and the existence of pervasive extra-contractual or undocumented terms or arrangements. These prior business practices and the lack of transparency surrounding them created a systemically implied right for customers to demand future, unknown performance by the Company. Although some of the former executives were employed by the Company only through June 2018, the Company determined that based on the impact of the prior tone at the top, the continued internal sales force strategy and the existing customer base’s continued expectations (based on past practice), there would be flexibility with respect to arrangement terms even after delivery of the product so pervasive that all customer arrangements continued to be subject to uncertain modification of terms into 2019. After identifying the primary factors contributing to the lack of knowledge regarding its customer contractual terms, the Company began implementing changes in mid-2018 to remediate the pervasive weaknesses in the control environment, followed by gradually implementing measures to empower its compliance, legal, and accounting departments, educating its sales force on appropriate business practices, and communicating its revised terms of sale to customers. The Company assessed its efforts throughout 2019 to determine when, if at any point, the factors contributing to the inability to satisfy the Step 1 Criteria were sufficiently addressed such that the Step 1 Criteria were met at the time of physical delivery to the customer. Determining when these conditions were effectively satisfied was a matter of judgment; however, the Company determined that adequate knowledge of the contractual arrangements with its customers did exist in 2019. Management did note that there is no single determinative change that overcame the pervasive challenges noted above, but rather an accumulation of efforts that taken together, resulted in sufficient knowledge of contractual relationships both internally within the Company and externally with its customers. To address the tone at the top issues, the Company noted that proper remediation involved not only the removal of members of management that were setting an inappropriate tone but also the establishment of new management throughout the organization that emphasized a commitment to integrity, ethical values and transparency and have that reinforcement for a sustained period of time. The changes made to management positions throughout the organization and the resulting organization behavior changes were assessed to have been sufficiently addressed by mid-2019. Therefore, beginning October 1, 2019, for all new customer arrangements, the Company determined adequate measures were in place to understand the terms of its contracts with customers. As such, beginning October 1, 2019, the Company concluded that the Step 1 Criteria would be met prior to shipment of product to the customer or implantation of the products on consignment. For the remaining customer arrangements at September 30, 2019 (the “ Remaining Contracts ”), the Company concluded that due to the uncertainty that extracontractual arrangement may continue the Step 1 Criteria would not be satisfied until the Company receives payment from the customer. At that point, the Company determined that an accounting contract would exist and the performance obligations of the company to deliver product and the customer to pay for the product would be satisfied. As of March 31, 2020, upon reassessment, the Company concluded that the Step 1 Criteria continued to not be met due to the same circumstances described above. The amount related to these Remaining Contracts at March 31, 2020 was $4.5 million . Amounts Invoiced and Not Collected Deferred Cost of Sales Amounts as of December 31, 2019 $ 9,006 $ 1,261 Revenue recognized related to amounts invoiced and not collected at September 30, 2019: Cash collected during the three months ended March 31, 2020 related to the Remaining Contracts (4,495 ) (629 ) Amounts as of March 31, 2020 $ 4,511 $ 632 As a result of the reassessment as of September 30, 2019, the Company also determined that, for approximately $10.3 million of existing contracts where payment had not been received, it was not probable that substantially all consideration would be collected. For these customer contracts, the Company continued to fail the Step 1 Criteria and, therefore, no revenue was recognized in 2019. Any collections during the three months ended March 31, 2020, as well as any future collections relating to these customer contracts, will be recorded as revenue at the time payment is received. For all customer transactions concluded to meet the Step 1 Criteria, the Company then assessed the remaining criteria of ASC 606 to determine the proper timing of revenue recognition. Under ASC 606, the Company recognizes revenue following the five-step model: (i) identify the contracts with a customer (the Step 1 Criteria); (ii) identify the performance obligations in the contract; (iii) determine the transaction price; (iv) allocate the transaction price to the performance obligations in the contract; and (v) recognize revenue when (or as) the entity satisfies a performance obligation. As noted above, during the third quarter of 2019, the Company determined that they had met the Step 1 Criteria. The Company also determined that the performance obligation was met upon delivery of the product to the customer, or at the time the product is implanted for products on consignment, at which point the Company determined it will collect the consideration it is entitled to in exchange for the product transferred to the customer. As a result, the Company recognizes as revenue the amount of the transaction price that is allocated to the respective performance obligation when (or as) the performance obligation is satisfied, generally upon shipment of the product to the customer. The nature of the Company’s contracts gives rise to certain types of variable consideration, including rebates and other discounts. The Company includes estimated amounts of variable consideration in the transaction price to the extent that it is probable there will not be a significant reversal of revenue. Estimates are based on historical or anticipated performance. The Company does have consignment agreements with several customers and distributors which allow the Company to better market its products by moving them closer to the end user. In these cases, the Company determined that it has fulfilled its performance obligation once control of the product has been delivered to the customer, which occurs simultaneously with the product being implanted. The Company acts as the principal in all of its customer arrangements and therefore records revenue on a gross basis. Shipping is considered immaterial in the context of the overall customer arrangement, and damages or loss of goods in transit are rare. Therefore, shipping is not deemed a separately recognized performance obligation. The Company maintains a returns policy that allows its customers to return product that is consigned, damaged or non-conforming, ordered in error, or due to a recall. The estimate of the provision for returns is based upon historical experience with actual returns. The Company’s payment terms for customers are typically 30 to 60 days from receipt of title of the goods. Subsequent to the Transition, the Company continued to defer the cost of sales for certain arrangements for which all revenue recognition criteria have not been met. These amounts were recorded within other current assets on the consolidated balance sheet in the amount of $0.6 million and $1.3 million as of March 31, 2020 and December 31, 2019, respectively. GPO Fees The Company sells to Group Purchasing Organization (“ GPO ”) members who transact directly with the Company at GPO-agreed pricing. GPOs are funded by administrative fees that are paid by the Company. These fees are set as a percentage of the purchase volume, which is typically 3% of sales made to the GPO members. The Company presents the administrative fees paid to GPOs as a reduction of revenues because the benefit received by the Company in exchange for the GPO fees is not sufficiently separable from the GPO member’s purchase of the Company’s products. Cost of Sales Cost of sales includes all costs directly related to bringing the Company’s products to their final selling destination. Amounts include direct and indirect costs to manufacture products including raw materials, personnel costs and direct overhead expenses necessary to convert collected tissues into finished goods, product testing costs, quality assurance costs, facility costs associated with the Company’s manufacturing and warehouse facilities, depreciation, freight charges, costs to operate equipment and other shipping and handling costs for products shipped to customers. Leases Effective January 1, 2019, the Company accounts for its leases under ASC 842, “ Leases ”. The Company determines if an arrangement is, or contains, a lease at inception. Right-of-use assets and the related liabilities result from operating leases were included in Right of use asset, Other current liabilities and Other liabilities, respectively, in the condensed consolidated balance sheets as of March 31, 2020 and December 31, 2019. Operating lease assets represent the Company’s right to use an underlying asset for the lease term and lease liabilities represent the Company’s obligation to make lease payments arising from the lease. Operating lease assets and liabilities are recognized at the lease commencement date based on the estimated present value of lease payments over the lease term. The lease term used in the calculation includes options to extend or terminate the lease when the exercise of such options are reasonably certain. The Company uses the estimated incremental borrowing rate in determining the present value of lease payments. Variable components of the lease payments such as fair market value adjustments, utilities, and maintenance costs are expensed as incurred and not included in determining the present value of lease liabilities. As an accounting policy election, the Company excludes short-term leases having initial terms of 12 months or fewer. Lease expense is recognized on a straight-line basis over the lease term. See Note 6, “ Leases ” for further information regarding lease obligations. Patent Costs The Company incurs certain legal and related costs in connection with patent applications for tissue-based products and processes. The Company capitalizes such costs as patents in progress until a patent is obtained. When a patent is issued, the costs are amortized over the expected life of the patent to the extent that an economic benefit is anticipated from the resulting patent or alternative future use is available to the Company. If a patent is not obtained, costs are expensed. Patents are included in Intangible assets in the condensed consolidated balance sheet. The Company capitalized approximately $0.1 million and $0.2 million of patent costs during the first three months of 2020 and 2019 , respectively. Treasury Stock The Company accounts for the purchase of treasury stock under the cost method. Treasury stock which is reissued for the exercise of option grants and the issuance of restricted stock grants is accounted for on a FIFO basis. Recently Issued Accounting Standards Adopted by the Company In February 2016, FASB issued ASU No. 2016-02, “ Leases (Topic 842) ”, which amended the guidance on accounting for leases. The FASB issued this update to increase transparency and comparability among organizations. This update requires the recognition of lease assets and lease liabilities on the balance sheet and the disclosure of key information about leasing arrangements. The Company adopted the ASU effective January 1, 2019 using the additional (optional) approach, in accordance with ASU 2018-11, “ Leases (Topic 842): Targeted Improvements .” Upon adoption, the Company recorded a right of use asset of $4.3 million and a right of use liability of $5.2 million . The right of use asset, in its entirety, is included in Right of use assets, net on the condensed consolidated balance sheet. Right of use liabilities are included in Other current liabilities to the extent that such liabilities are expected to be settled within one year and Other liabilities to the extent that such obligations are due more than one year from the balance sheet date. The difference between the right of use asset and liability relates to rent credits which existed as of January 1, 2019. There was no effect on opening retained earnings at adoption. In adopting the new lease standard, the Company elected the permitted package of practical expedients permitted, which allowed the Company to account for existing leases under their current classification, as well as omit any new costs classified as initial direct costs, under the new standard. See Note 6 for additional information on leases. In February 2018, the FASB issued ASU No. 2018-02, “ Income Statement - Reporting Comprehensive Income (Topic 220) ,” to address certain income tax effects in Accumulated Other Comprehensive Income (“ AOCI ”) resulting from the tax reform enacted in 2017. The amended guidance provides an option to reclassify tax effects within AOCI to retained earnings in the period in which the effect of the tax reform is recorded. The amendments were effective for fiscal years beginning after December 15, 2018, including interim periods. The Company adopted this ASU on January 1, 2019, which did not have any impact on the Company’s results of operations or financial condition as there were no balances in AOCI that are tax effected. In June 2018, the FASB issued ASU 2018-07, “ Compensation-Stock Compensation (Topic 718): Improvements to Non-employee Share-Based Payment Accounting ” (“ ASU 2018-07 ”), which simplifies the accounting for share-based payments to non-employees by aligning it with the accounting for share-based payments to employees, with certain exceptions. Under the new guidance, the measurement of equity-classified nonemployee awards will be fixed at the grant date. ASU 2018-07 is effective for interim and annual reporting periods beginning after December 15, 2018 and early adoption was permitted. The Company adopted the new standard on January 1, 2019. The adoption of ASU 2018-07 did not have a material impact on the Company’s consolidated financial statements and related disclosures . In June 2016, the FASB issued ASU 2016-13, “ Financial Instruments - Credit Losses (Topic 326): Measurement of Credit Losses on Financial Instruments ,” that introduces a new model for recognizing credit losses on financial instruments based on an estimate of current expected credit losses. This includes accounts receivable, trade receivables, loans, held-to-maturity debt securities, net investments in leases and certain off-balance sheet credit exposures. The guidance also modifies the impairment model for available-for-sale debt securities. The ASU is effective for fiscal years and interim periods within those fiscal years beginning after December 15, 2019. The Company adopted this ASU on January 1, 2020 using a modified retrospective transition method which requires a cumulative-effect adjustment to the opening balance of retained earnings to be recognized on the date of adoption with no change to financial results reported in prior periods. The cumulative effect adjustment recorded on January 1, 2020 is not material. The adoption of this ASU did not have a significant impact on the Company’s consolidated financial statements and related disclosures. All other ASUs issued and not yet effective for the three months ended March 31, 2020 , and through the date of this report, were assessed and determined to be either not applicable or are expected to have minimal impact on the Company’s financial position or results of operations.

Liquidity and Capital Resources

Liquidity and Capital Resources	3 Months Ended
	Mar. 31, 2020
Liquidity and Capital Resources [Abstract]
Liquidity and Capital Resources	Liquidity and Capital Resources Net Working Capital As of March 31, 2020 , the Company had approximately $53.5 million of cash and cash equivalents. The Company reported total current assets of approximately $115.9 million and current liabilities of approximately $63.7 million as of March 31, 2020 . Overall Liquidity and Capital Resources The Company’s largest cash requirement for the three months ended March 31, 2020 was cash for general working capital needs and capital expenditures. The Company funded its cash requirements through its existing cash reserves, and the Term Loan that closed in June 2019. The Company believes that its anticipated cash from operating and financing activities and existing cash and cash equivalents will enable the Company to meet its operational liquidity needs and fund its planned investing activities for the next year from the date these financial statements were available to be issued. Issuance of $100 Million of Series B Convertible Preferred Stock On July 2 , 2020, the Company issued $100 million of the Company’s Series B Convertible Preferred Stock, par value $0.001 per share (the “ Series B Preferred Stock ”) to an affiliate of EW Healthcare Partners and to certain funds managed by Hayfin Capital Management LLP pursuant to a Securities Purchase Agreement with Falcon Fund 2 Holding Company, L.P., an affiliate of EW Healthcare Partners, and certain funds managed by Hayfin Capital Management LLP , dated as of June 30 , 2020 (the “ Securities Purchase Agreement ”), for an aggregate purchase price of $100 million (the “ Preferred Stock Transaction ”). $75 Million Loan Facility with Hayfin On June 30, 2020, the Company entered into a Loan Agreement with, among others, Hayfin Services LLP, an affiliate of Hayfin Capital Management LLP (the “ Hayfin Loan Agreement ”), which funded on July 2, 2020 (the “Hayfin Loan Transaction”) and provided the Company with a senior secured term loan in an aggregate amount of $50 million (the “ Hayfin Term Loan ”) and an additional $25 million delayed draw term loan (the “ DD TL ”) in the form of a committed but undrawn facility. The Hayfin Term Loan and the DD TL mature on July 2, 2025 (the “Maturity Date”). The Hayfin Term Loan and the DD TL have no fixed amortization (i.e. interest only through the Maturity Date). Borrowings under the Hayfin Loan Agreement bear interest at a rate equal to LIBOR (subject to a floor of 1.5% ) plus a margin of 6.75% . The margin will be eligible to step down to 6.5% or 6.0% based on future Total Net Leverage levels, as defined in the Hayfin Loan Agreement. The Company paid an upfront commitment fee of 2% of the aggregate of the Hayfin Term Loan and the DD TL. The DD TL is subject to an additional commitment fee of 1% of the amount undrawn. The Hayfin Loan Agreement also contains certain affirmative covenants that impose certain reporting and/or performance obligations on the Company and its subsidiaries, including (i) Maximum Total Net Leverage of 5.0 x through December 31, 2020, stepping down to 4.5 x through June 30, 2021, and to 4.0 x thereafter until the Maturity Date; (ii) Cap on Cash Netting for the purposes of calculating Total Net Leverage set at $10,000,000 ; (iii) DD TL Incurrence Covenant of 3.5 x Total Net leverage, tested prior to any drawings under the DD TL; and (iv) Minimum Liquidity of $10,000,000 , an at-all-times covenant tested monthly. Repayment and Termination of BT Loan Agreement On July 2, 2020, the Company repaid the remaining $72.0 million of principal and accrued interest of $0.1 million under the loan agreement, dated as of June 10, 2019, by and among the Company, the subsidiaries of the Company as guarantors party thereto from time to time, the lenders party thereto from time to time, and Blue Torch Finance LLC (“ Blue Torch ”), as administrative agent and collateral agent, as amended by that certain First Amendment thereto, dated as of April 22, 2020 (the “ BT Loan Agreement ”), and terminated the BT Loan Agreement. As a result of the early termination of the BT Loan Agreement, the Company also incurred a prepayment premium of $1.4 million , which it paid with a portion of the proceeds from the Preferred Stock Transaction and the Hayfin Loan Transaction, as described above. For more information regarding the Preferred Stock Transaction, the Hayfin Loan Transaction, and the repayment of the BT Term Loan (as defined below) refer to Item 9B of the 2019 Form 10-K.

Inventory

Inventory	3 Months Ended
	Mar. 31, 2020
Inventory Disclosure [Abstract]
Inventory	Inventory Inventory consisted of the following (in thousands): March 31, 2020 December 31, 2019 Raw materials $ 330 $ 318 Work in process 3,913 4,299 Finished goods 5,587 5,206 Inventory, gross 9,830 9,823 Reserve for obsolescence (583 ) (719 ) Inventory, net $ 9,247 $ 9,104

Property and Equipment

Property and Equipment	3 Months Ended
	Mar. 31, 2020
Property, Plant and Equipment [Abstract]
Property and Equipment	Property and Equipment Property and equipment consisted of the following (in thousands): March 31, 2020 December 31, 2019 Leasehold improvements $ 5,321 $ 5,321 Lab and clean room equipment 15,128 14,894 Furniture and office equipment 15,405 15,118 Construction in progress 1,463 972 Property and equipment, gross 37,317 36,305 Less accumulated depreciation (25,484 ) (23,977 ) Property and equipment, net $ 11,833 $ 12,328 Depreciation expense for the three months ended March 31, 2020 and 2019 , was approximately $1.5 million and $1.7 million , respectively.

Leases

Leases	3 Months Ended
	Mar. 31, 2020
Leases [Abstract]
Leases	Leases As discussed in Note 2, on January 1, 2019, MiMedx adopted new guidance for the accounting and reporting of leases. The Company has operating leases primarily for corporate offices, vehicles, and certain equipment. Such leases do not require any contingent rental payments, impose any financial restrictions, or contain any residual value guarantees. The Company determines if an arrangement is or contains a lease at inception. Under ASC 842 transition guidance, the Company has not elected the hindsight practical expedient to determine the lease term for existing leases, which permits companies to consider available information prior to the effective date of the new guidance as to the actual or likely exercise of options to extend or terminate the lease. Certain of the Company’s leases include renewal options and escalation clauses; renewal options have not been included in the calculation of the lease liabilities and right of use assets as the Company is not reasonably certain to exercise the options. Lease expense for operating lease payments is recognized on a straight-line basis over the term of the lease. Operating lease assets and liabilities are recognized based on the present value of lease payments over the lease term. Since most of the Company’s leases do not have a readily determinable implicit discount rate, the Company uses its incremental borrowing rate to calculate the present value of lease payments. As a practical expedient, the Company has made an accounting policy election not to separate lease components from non-lease components in the event that the agreement contains both. The Company includes both the lease and non-lease components for purposes of calculating the right-of-use asset and related lease liability. The Company does not act as a lessor or have any leases classified as financing leases. Operating lease cost was $0.4 million for the three months ended March 31, 2020 and was recorded in Selling, general, and administrative expenses. Interest on lease obligations was $0.1 million for the three months ended March 31, 2019 and was recorded in Selling, general, and administrative expenses. Cash paid for amounts included in the measurement of operating lease liabilities was $0.4 million at March 31, 2020 . The amortization of leased assets was $0.2 million and $0.3 million for the three months ended March 31, 2020 and 2019 , respectively. Supplemental balance sheet information related to operating leases is as follows (amounts in thousands, except lease term and discount rate): March 31, 2020 December 31, 2019 Assets Right of use asset $ 3,158 $ 3,397 Liabilities Short term lease liability $ 1,195 $ 1,168 Long term lease liability $ 2,611 $ 2,919 Weighted-average remaining lease term (years) 2.8 3.1 Weighted-average discount rate 11.5 % 11.5 % Maturities of operating leases liabilities are as follows (amounts in thousands): Year ended December 31, Maturities 2020 (excluding the three months ended March 31, 2020) $ 1,170 2021 1,528 2022 1,552 2023 195 2024 — Thereafter — Total lease payments 4,445 Less: imputed interest (639 ) $ 3,806

Intangible Assets

Intangible Assets	3 Months Ended
	Mar. 31, 2020
Goodwill and Intangible Assets Disclosure [Abstract]
Intangible Assets	Intangible Assets Intangible assets are summarized as follows (in thousands): March 31, 2020 December 31, 2019 Gross Carrying Amount Accumulated Amortization Net Carrying Amount Gross Carrying Amount Accumulated Amortization Net Carrying Amount Amortized intangible assets Licenses $ 1,414 $ (1,234 ) $ 180 $ 1,414 $ (1,200 ) $ 214 Patents and know how 9,108 (5,232 ) 3,876 9,099 (5,070 ) 4,029 Customer and supplier relationships 3,761 (2,485 ) 1,276 3,761 (2,417 ) 1,344 Non-compete agreements 120 (75 ) 45 120 (68 ) 52 Total amortized intangible assets $ 14,403 $ (9,026 ) $ 5,377 $ 14,394 $ (8,755 ) $ 5,639 Unamortized intangible assets Trade names and trademarks $ 1,008 $ 1,008 $ 1,008 $ 1,008 Patents in process 1,196 1,196 1,130 1,130 Total intangible assets $ 16,607 $ 7,581 $ 16,532 $ 7,777 Amortization expense for the three months ended March 31, 2020 and 2019 , was approximately $0.3 million and $0.2 million , respectively. Expected future amortization of intangible assets as of March 31, 2020 , is as follows (in thousands): Year ending December 31, Estimated Amortization Expense 2020 (excluding the three months ended March 31, 2020) $ 739 2021 978 2022 955 2023 955 2024 955 Thereafter 795 $ 5,377

Accrued Expenses

Accrued Expenses	3 Months Ended
	Mar. 31, 2020
Payables and Accruals [Abstract]
Accounts Expenses	Accrued Expenses Accrued expenses include the following (in thousands): March 31, 2020 December 31, 2019 Legal costs $ 13,302 $ 12,202 Settlement costs 5,931 5,931 Pricing adjustment settlement with Veterans Affairs 6,894 6,894 Estimated returns 1,567 2,581 External commissions 1,328 1,722 Accrued clinical trials 566 1,076 Other 1,073 1,755 Total $ 30,661 $ 32,161

Long Term Debt

Long Term Debt	3 Months Ended
	Mar. 31, 2020
Debt Disclosure [Abstract]
Long Term Debt	Long-Term Debt On June 10, 2019, the Company entered into the BT Loan Agreement, pursuant to which the full amount was borrowed and funded (the “ BT Term Loan ”). The proceeds from the BT Term Loan were used (i) for working capital and general corporate purposes and (ii) to pay transaction fees, costs and expenses incurred in connection with the BT Term Loan and the related transactions. The BT Term Loan would have matured on June 20, 2022 and was repayable in quarterly installments of $0.9 million ; the balance was due on June 20, 2022. Blue Torch maintained a first-priority security interest in substantially all the Company’s assets. The BT Term Loan was issued net of the original issue discount of $2.3 million . The Company also incurred $6.7 million of deferred financing costs. As of March 31, 2020, interest applicable to any borrowings under the BT Term Loan accrued at a rate equal to LIBOR plus a margin of 8.00% per annum. The BT Term Loan had an interest rate equal to 10.46% at the time the BT Loan Agreement was executed and an interest rate as of March 31, 2020 was 9.95% . The BT Loan Agreement originally contained financial covenants requiring the Company, on a consolidated basis, to maintain the following: • Maximum Total Leverage Ratio, defined as funded debt divided by consolidated adjusted EBITDA, of not more than 3.0 to 1.0 as of the last day of the previous four consecutive fiscal quarters. • Minimum Liquidity, defined as unrestricted cash and cash equivalents, of less than $40.0 million as of the last business day of each fiscal month following the BT Term Loan closing date through and including the fiscal month ending May 31, 2020. For fiscal months beginning June 30, 2020, the Company was not permitted to have liquidity of less than $30.0 million . Beginning with the fiscal month ending December 31, 2020, if the total leverage ratio is less than 2.50 to 1.0 as of the last business day of any fiscal month, the Company’s liquidity was not permitted to be less than $20.0 million . The BT Term Loan was amended on April 22, 2020 to, among other things, modify the financial covenants. See Note 15, “ Subsequent Events ,” of the consolidated financial statements. The BT Loan Agreement also specified that any prepayment of the loan, voluntary or mandatory, as defined in the BT Loan Agreement, subjected MiMedx to a prepayment penalty as of the date of the prepayment with respect to the BT Term Loan of: • During the period from June 10, 2019 through June 10, 2020, an amount equal to 3% of the principal amount of the BT Term Loan prepaid on such date; and • During the period from June 11, 2020 through June 10, 2021, an amount equal to 2% of the principal amount of the BT Term Loan prepaid on such date. Principal prepayments after June 10, 2021 were not subject to a prepayment penalty. The BT Loan Agreement also included events of default customary for facilities of this type, and upon the occurrence of such events of default, subject to customary cure rights, all outstanding loans under the BT Loan Agreement could have been accelerated and/or the lenders’ commitments terminated. The balances of the BT Term Loan were as follows (amounts in thousands): March 31, 2020 December 31, 2019 Current portion Long-term Current portion Long-term Liability component - principal $ 3,750 $ 68,438 $ 3,750 $ 69,375 Original issue discount — (1,723 ) — (1,890 ) Deferred financing cost — (5,078 ) — (5,579 ) Liability component - net carrying value $ 3,750 $ 61,637 $ 3,750 $ 61,906 Interest expense related to the BT Term Loan, included in Interest income (expense), net in the consolidated statements of operations, was as follows (amounts in thousands): For the Three Months Ended March 31, 2020 Interest expense - stated interest rate $ 1,840 Interest expense - amortization of original issue discount and costs 167 Interest expense - amortization of deferred financing costs 491 Total term loan interest expense $ 2,498 The future principal payments for the Company’s BT Term Loan as of March 31, 2020 were as follows (in thousands): Year ending December 31, Principal 2020 (excluding the three months ended March 31, 2020) $ 2,088 2021 3,750 2022 66,350 2023 — 2024 — Thereafter — Total Long Term Debt $ 72,188 As of March 31, 2020 , the fair value of the Company’s BT Term Loan was $62.7 million . This valuation was calculated based on a series of Level 2 and Level 3 inputs by calculating a discount rate based on the credit risk spread of debt instruments of a similar risk character in reference to U.S. Treasury instruments with identical securities, with an incremental risk premium for Company-specific risk factors. The remaining cash flows associated with the BT Term Loan were discounted to March 31, 2020 with this calculated discount rate to derive the fair value as of that date. As described above in Note 3, “ Liquidity and Capital Resources ,” on July 2, 2020, a portion of the proceeds from the Preferred Stock Transaction and the Hayfin Loan Transaction were used to repay the outstanding balance of principal, accrued but unpaid interest, and prepayment premium under the BT Loan Agreement. In connection with the repayment of the BT Term Loan, the Company terminated the BT Loan Agreement. Additionally, on July 2, 2020, the Company borrowed an aggregate of $50 million pursuant to the Hayfin Loan Agreement, and obtained an additional committed but undrawn $25 million facility pursuant to the Hayfin Loan Agreement, as described above in Note 3, “ Liquidity and Capital Resources .”

Net Loss Per Share

Net Loss Per Share	3 Months Ended
	Mar. 31, 2020
Earnings Per Share [Abstract]
Net Loss Per Share	Net Loss Per Share Basic net loss per common share is computed using the weighted-average number of common shares outstanding during the period. Diluted net loss per common share is computed using the weighted-average number of common and dilutive common equivalent shares from stock options, restricted stock and warrants using the treasury stock method. The following table sets forth the computation of basic and diluted net income per share (in thousands except share data): Three Months Ended March 31, 2020 2019 Net loss $ (4,821 ) $ (13,273 ) Denominator for basic earnings per share - weighted average shares 107,538,509 106,420,317 Effect of dilutive securities: Stock options, restricted stock, and warrants outstanding(a) 2,706,804 803,487 Denominator for diluted earnings per share - weighted average shares adjusted for dilutive securities 107,538,509 106,420,317 Loss per common share - basic $ (0.04 ) $ (0.12 ) Loss per common share - diluted $ (0.04 ) $ (0.12 ) (a) Securities outstanding that are included in the computation above, utilizing the treasury stock method are as follows: Three Months Ended March 31, 2020 2019 Outstanding Stock Options 919,555 609,292 Performance Based Awards 17,402 — Restricted Stock Awards 1,769,847 194,195 2,706,804 803,487

Income Taxes

Income Taxes	3 Months Ended
	Mar. 31, 2020
Income Tax Disclosure [Abstract]
Income Taxes	Income Taxes The effective tax rates for the Company of 70.1% and 0.3% for the three months ended March 31, 2020 and March 31, 2019 , respectively includes the impact of discrete items of approximately $11.4 million in 2020 and $0 in 2019. As of March 31, 2020, the projected annual effective tax rate for 2020 is (0.6)% . The discrete items recorded for the three months ended March 31, 2020 are primarily related to modifications to the tax rules for carryback of net operating losses as a result of the CARES Act which are expected to result in a federal tax refund of approximately $11.3 million and an income tax benefit of the same amount. No

Supplemental Disclosure of Cash

Supplemental Disclosure of Cash Flow and Non-cash Investing and Financing Activities	3 Months Ended
	Mar. 31, 2020
Supplemental Cash Flow Elements [Abstract]
Supplemental Disclosure of Cash Flow and Non-cash Investing and Financing Activities	Supplemental Disclosure of Cash Flow and Non-Cash Investing and Financing Activities Selected cash payments, receipts, and noncash activities are as follows (in thousands): Three Months Ended March 31, 2020 2019 Cash paid for interest $ 1,840 $ 1 Income taxes paid 6 46

Contractual Commitments and Con

Contractual Commitments and Contingencies	3 Months Ended
	Mar. 31, 2020
Commitments and Contingencies Disclosure [Abstract]
Contractual Commitments and Contingencies	Contractual Commitments and Contingencies Contractual Commitments In addition to the leases noted under Note 6 “ Leases ,” the Company has commitments for meeting space. These leases expire over 3 to 3.5 years following March 31, 2020, and generally contain renewal options. The Company anticipates that most of these leases will be renewed or replaced upon expiration. Rent expense for the three months ended March 31, 2020 and 2019 , was approximately $0.3 million and $0.4 million , respectively, and is allocated among cost of sales, research and development, and selling, general and administrative expenses. Separation and Transition Services Agreement of Edward J. Borkowski On November 18, 2019, the Company entered into a Separation and Transition Services Agreement (“ Separation Agreement ”) with Edward J. Borkowski, under which Mr. Borkowski resigned as Executive Vice President and Interim Chief Financial Officer of the Company, as well as from any and all officer, director or other positions that he held with the Company and its affiliates, effective November 15, 2019. Pursuant to the Separation Agreement, Mr. Borkowski agreed to perform the duties of the Interim Chief Financial Officer with respect to the Company’s Annual Report on Form 10-K for the year ended December 31, 2018 (the “ 2018 Form 10-K ”) and assist with the transition of his duties as described in the Separation Agreement from November 15, 2019 through the earlier of the first business day following the Company’s filing of its 2018 Form 10-K with the SEC or December 31, 2019 (the “ Transition Period ”). From the end of the Transition Period until March 31, 2020, Mr. Borkowski agreed to provide services as may be requested by the Company with respect to matters related to the 2018 Form 10-K and the 2019 Form 10-K. The Company has paid Mr. Borkowski the full amount of $4.0 million as of July 6, 2020. Litigation and Regulatory Matters In the ordinary course of business, the Company and its subsidiaries are parties to numerous civil claims and lawsuits and subject to regulatory examinations, investigations, and requests for information. Some of these matters involve claims for substantial amounts. The Company’s experience has shown that the damages alleged by plaintiffs or claimants are often overstated, based on unsubstantiated legal theories, unsupported by facts, and/or bear no relation to the ultimate award that a court might grant. Additionally, the outcome of litigation and regulatory matters and the timing of ultimate resolution are inherently difficult to predict. These factors make it difficult for the Company to provide a meaningful estimate of the range of reasonably possible outcomes of claims in the aggregate or by individual claim. However, on a case-by-case basis, reserves are established for those legal claims in which it is probable that a loss will be incurred and the amount of such loss can be reasonably estimated. The Company's financial statements at March 31, 2020 reflect the Company's current best estimate of probable losses associated with these matters, including costs to comply with various settlement agreements, where applicable. The actual costs of resolving these claims may be substantially higher or lower than the amounts reserved. For more information regarding the Company’s legal proceedings, refer to the disclosure under Item 3, “ Legal Proceedings ” and Note 16, “ Commitments and Contingencies ” in the Company’s 2019 Form 10-K, which disclosure is incorporated herein by reference. The following is a description of certain litigation and regulatory matters: Shareholder Derivative Suits On December 6, 2018, the United States District Court for the Northern District of Georgia entered an order consolidating three shareholder derivative actions ( Evans v. Petit, et al. filed September 25, 2018, Georgalas v. Petit, et al. filed September 27, 2018, and Roloson v. Petit, et al. filed October 22, 2018) that had been filed in the Northern District of Georgia. On January 22, 2019, plaintiffs filed a verified consolidated shareholder derivative complaint. The consolidated action sets forth claims of breach of fiduciary duty, corporate waste and unjust enrichment against certain former officers, and certain current and former directors, of the Company: Parker H. Petit, William C. Taylor, Michael J. Senken, John E. Cranston, Alexandra O. Haden, Joseph G. Bleser, J. Terry Dewberry, Charles R. Evans, Larry W. Papasan, Luis A. Aguilar, Bruce L. Hack, Charles E. Koob, Neil S. Yeston and Christopher M. Cashman. The allegations generally involve claims that the defendants breached their fiduciary duties by causing or allowing the Company to misrepresent its financial statements as a result of improper revenue recognition. The Company filed a motion to stay on February 18, 2019, pending the completion of the investigation by the Company’s Special Litigation Committee. The Special Litigation Committee completed its investigation relating to this action and filed an executive summary of its findings with the Court on July 1, 2019. The parties (together with parties from the Hialeah derivative lawsuit, the Nix and Demaio derivative lawsuit, and the Murphy derivative lawsuit, each described below) held a mediation on February 11, 2020. Following continued discussions, on May 1, 2020, the parties notified the Court that plaintiffs and the Company had reached an agreement in principle to settle this consolidated derivative action, which settlement also encompasses all claims asserted in the Hialeah derivative lawsuit, the Nix and Demaio derivative lawsuit, and the Murphy derivative lawsuit. As of the date of the filing of this Form 10-Q, the parties are drafting, and intend to file, a stipulation of settlement and motion seeking preliminary approval of the settlement. On February 10, 2020, Charles Pike filed a shareholder derivative complaint in the United States District Court for the Southern District of Florida ( Pike v. Petit, et al. ). The complaint alleges claims for breaches of fiduciary duty against certain former officers, and certain current and former directors, of the Company: Parker H. Petit, William C. Taylor, Michael J. Senken, John E. Cranston, Charles R. Evans, Luis A. Aguilar, Joseph G. Bleser, J. Terry Dewberry, Bruce L. Hack, Charles E. Koob, Larry W. Papasan and Neil S. Yeston. Similar to the prior-filed actions discussed above, the allegations generally involve claims that the defendants breached their fiduciary duties by causing or allowing the Company to misrepresent its financial statements as a result of improper revenue recognition. On May 12, 2020, prior to the Company’s time to respond to the complaint, the plaintiff filed a notice of voluntary dismissal of this action without prejudice. On February 18, 2020, Bruce Cassamajor filed a shareholder derivative complaint in the United States District Court for the Northern District of Florida (C assamajor v. Petit, et al. ). The complaint alleges claims for breaches of fiduciary duty against certain former officers, and certain current and former directors, of the Company: Parker H. Petit, William C. Taylor, Michael J. Senken, John E. Cranston, Charles R. Evans, Luis A. Aguilar, Joseph G. Bleser, J. Terry Dewberry, Bruce L. Hack, Charles E. Koob, Larry W. Papasan and Neil S. Yeston. Similar to the prior-filed actions discussed above, the allegations generally involve claims that the defendants breached their fiduciary duties by causing or allowing the Company to misrepresent its financial statements as a result of improper revenue recognition. On May 22, 2020, prior to service of the complaint, the plaintiff filed a notice of voluntary dismissal of this action without prejudice. On May 26, 2020, the court ordered this case to be dismissed for failure to serve process. Securities Class Action On January 16, 2019, the United States District Court for the Northern District of Georgia entered an order consolidating two purported securities class actions ( MacPhee v. MiMedx Group, Inc., et al. filed February 23, 2018 and Kline v. MiMedx Group, Inc., et al. filed February 26, 2018). The order also appointed Carpenters Pension Fund of Illinois as lead plaintiff. On May 1, 2019, the lead plaintiff filed a consolidated amended complaint, naming as defendants the Company, Michael J. Senken, Parker H. Petit, William C. Taylor, Christopher M. Cashman and Cherry Bekaert & Holland LLP. The amended complaint (the “ Securities Class Action Complaint ”) alleged violations of Section 10(b) of the Securities Exchange Act of 1934, as amended (the “ Exchange Act ”), Rule 10b-5 promulgated thereunder and Section 20(a) of the Exchange Act. It asserted a class period of March 7, 2013 through June 29, 2018. Following the filing of motions to dismiss by the various defendants, the lead plaintiff was granted leave to file an amended complaint. The lead plaintiff filed its amended complaint against the Company, Michael Senken, Pete Petit, William Taylor, and Cherry Bekaert & Holland (Christopher Cashman was dropped as a defendant) on March 30, 2020; defendants filed motions to dismiss on May 29, 2020. Investigations United States Attorney’s Office for the Southern District of New York (“ USAO-SDNY ”) Investigation The USAO-SDNY is conducting an investigation into, among other things, the Company’s recognition of revenue and practices with certain distributors and customers. The USAO-SDNY requested that the Company provide it with copies of all information the Company furnished to the SEC staff and made additional requests for information. The USAO-SDNY conducted interviews of various individuals, including employees and former employees of the Company. In November 2019, former executives Messrs. Petit and Taylor were indicted for securities fraud and conspiracy to commit securities fraud, to make false filings with the SEC, and to influence improperly the conduct of audits relating to alleged misconduct that resulted in inflated revenue figures for fiscal 2015. The Company is cooperating with the USAO-SDNY. Department of Veterans’ Affairs Office of Inspector General (“ VA-OIG ”) and Civil Division of the Department of Justice (“ DOJ-Civil ”) Subpoenas and/or Investigations VA-OIG has issued subpoenas to the Company seeking, among other things, information concerning the Company’s financial relationships with VA clinicians. DOJ-Civil has requested similar information. The Company has cooperated fully and produced responsive information to VA-OIG and DOJ-Civil. Periodically, VA-OIG has requested additional documents and information regarding payments to individual VA clinicians. Most recently, on June 3, 2020, the Company received a subpoena from the VA-OIG requesting information regarding the Company’s financial relationships and interactions with two healthcare providers at the VA Long Beach Healthcare System. The Company has continued to cooperate and respond to these requests. As part of its cooperation, the Company provided documents in response to subpoenas concerning its relationship with three now former VA employees in South Carolina, who were ultimately indicted in May 2018. Among other things, the indictment referenced speaker fees paid by the Company to the former VA employees and other interactions between now former Company employees and the former VA employees. In January 2019, prosecution was deferred for 18 months to allow the three former VA employees to enter and complete a Pretrial Diversion Program, the completion of which would result in the dismissal of the indictment. As far as the Company is aware, two of the former VA employees have completed the program early and the indictment has been dismissed with respect to them. To date, no actions have been taken against the Company with respect to this matter. United States Attorney’s Office for the Middle District of North Carolina (“ USAO-MDNC ”) Investigation On January 9, 2020, the USAO-MDNC informed the Company that it is investigating the Company’s financial relationships with two former clinicians at the Durham VA Medical Center. The Company is cooperating with the investigation. Qui Tam Actions On January 19, 2017, a former employee of the Company filed a qui tam False Claims Act complaint in the United States District Court for the District of South Carolina ( United States of America, ex rel. Jon Vitale v. MiMedx Group, Inc. ) alleging that the Company’s donations to the patient assistance program, Patient Access Network Foundation, violated the Anti-Kickback Statute and resulted in submission of false claims to the government. The government declined to intervene and the complaint was unsealed on August 10, 2018. The Company filed a motion to dismiss on October 1, 2018. The Company’s motion to dismiss was granted in part and denied in part on May 15, 2019. The case is in discovery. Former Employee Litigation On November 19, 2018, the Company’s former Chief Financial Officer filed a complaint in the Superior Court for Cobb County, Georgia ( Michael J. Senken v. MiMedx Group, Inc. ) in which he claims that the Company has breached its obligations under the Company’s charter and bylaws to advance to him, and indemnify him for, his legal fees and costs that he incurred in connection with certain Company internal investigations and litigation. The Company filed its answer denying the plaintiff’s claims on April 19, 2019. To date, no deadlines have been established by the court. On January 21, 2019, a former employee filed a complaint in the Fifth Judicial Circuit, Richland County, South Carolina ( Jon Michael Vitale v. MiMedx Group, Inc. et. al. ) against the Company alleging retaliation, defamation and unjust enrichment and seeking monetary damages. The former employee claims he was retaliated against after raising concerns related to insurance fraud and later defamed by comments concerning the indictments of three South Carolina VA employees. On February 19, 2019, the case was removed to the U.S. District Court for the District of South Carolina. The Company filed a motion to dismiss on April 8, 2019, which was denied by the Court. This case is in discovery. In December 2019, MiMedx received notice of a complaint filed in July 2018 with the Occupational Safety and Health Administration (“OSHA”) section of the Department of Labor (“DOL”) by Thomas Tierney, a former Regional Sales Director, against MiMedx and the referenced individuals, Tierney v. MiMedx Group, Inc., Parker Petit, William Taylor, Christopher Cashman, Thornton Kuntz, Jr. and Alexandra Haden, DOL No. 4-5070-18-243. Mr. Tierney alleged that he was terminated from MiMedx in retaliation for reporting concerns about revenue recognition practices, compliance issues, and the corporate culture, in violation of the anti-retaliation provisions of the Sarbanes-Oxley Act. The parties settled this matter and OSHA dismissed the complaint on May 20, 2020. Defamation Claims On June 4, 2018, Sparrow Fund Management, LP (“ Sparrow ”) filed a complaint against the Company and Mr. Petit, including claims for defamation and civil conspiracy in the United States District Court for the Southern District of New York ( Sparrow Fund Management, L.P. v. MiMedx Group, Inc. et. al. ). The complaint seeks monetary damages and injunctive relief and alleges the defendants commenced a campaign to publicly discredit Sparrow by falsely claiming it was a short seller who engaged in illegal and criminal behavior by spreading false information in an attempt to manipulate the price of our Common Stock. On March 31, 2019, a judge granted defendants’ motions to dismiss in full, but allowed Sparrow the ability to file an amended complaint. The Magistrate has recommended Sparrow’s motion for leave to amend be granted in part and denied in part and the Judge adopted the Magistrate’s recommendation. Sparrow filed its amended complaint against MiMedx (Mr. Petit has been dropped from the lawsuit) on April 3, 2020 and the Company filed its answer. This case is in discovery. On June 17, 2019, the principals of Viceroy Research (“ Viceroy ”), filed suit in the Circuit Court for the Seventeenth Judicial Circuit in Broward County, Florida ( Fraser John Perring et. al. v. MiMedx Group, Inc. et. al. ) against the Company and Mr. Petit, alleging defamation and malicious prosecution based on the defendants’ alleged campaign to publicly discredit Viceroy and the lawsuit the Company previously filed against the plaintiffs, but which the Company subsequently dismissed without prejudice. On November 1, 2019, the Court granted Mr. Petit’s motion to dismiss on jurisdictional grounds, denied the Company’s motion to dismiss, and granted plaintiffs leave to file an amended complaint to address the deficiencies in its claims against Mr. Petit, which they did on November 21, 2019. The Company filed its answer on December 20, 2019. Intellectual Property Litigation The NuTech Action On March 2, 2015, the Company filed a patent infringement lawsuit against NuTech Medical, Inc. (“ NuTech ”) and DCI Donor Services, Inc. (“ DCI ”) in the United States District Court for the Northern District of Alabama ( MiMedx Group, Inc. v. NuTech Medical, Inc. et. al. ). The Company has alleged that NuTech and DCI infringed and continue to infringe the Company’s patents through the manufacture, use, sale and/or offering of their tissue graft product. The Company has also asserted that NuTech knowingly and willfully made false and misleading representations about its products to customers and prospective customers. The Company is seeking permanent injunctive relief and unspecified damages. The case was stayed pending the restatement of the Company’s financial statements. Since the Company has completed its restatement, the case has resumed and discovery has recommenced. The Osiris Action On February 20, 2019, Osiris Therapeutics, Inc. (“ Osiris ”) refiled its trade secret and breach of contract action against the Company (which had been dismissed in a different forum) in the United States District Court for the Northern District of Georgia ( Osiris Therapeutics, Inc. v. MiMedx Group, Inc. ). Osiris has alleged that the Company acquired Stability, a former distributor of Osiris, in order to illegally obtain trade secrets. On February 24, 2020, the Court issued an order granting in part and denying in party MiMedx’s motion to dismiss. The Court dismissed Osiris’s claims for tortious interference, conspiracy to breach contract, unfair competition, and conspiracy to commit unfair competition. The Court denied MiMedx’s motion to dismiss with respect to the claim for breach of the contract between Osiris and Stability, finding that there is a question as to whether Osiris can maintain such a claim by piercing the corporate veil between MiMedx and its former subsidiary. If Osiris cannot pierce the corporate veil, the claim against MiMedx fails; if Osiris can pierce the corporate veil, the breach of contract claim must be brought in an arbitration proceeding. MiMedx did not move to dismiss Osiris’s claims for misappropriation of trade secrets and conspiracy to misappropriate trade secrets. MiMedx plans to defend against all remaining claims. As of March 31, 2020, the Company has accrued approximately $12.8 million related to the legal proceedings discussed above. The Company has paid approximately $9.2 million to settle certain cases noted above. Other Matters Under the Florida Business Corporation Act and agreements with its current and former officers and directors, the Company is obligated to indemnify its current and former officers and directors who are made party to a proceeding, including a proceeding brought by or in the right of the corporation, with certain exceptions, and to advance expenses to defend such matters. The Company has already borne substantial costs to satisfy these indemnification and expense advance obligations and expects to continue to do so in the future. In addition to the matters described above, the Company is a party to a variety of other legal matters that arise in the ordinary course of the Company’s business, none of which is deemed to be individually material at this time. Due to the inherent uncertainty of litigation, there can be no assurance that the resolution of any particular claim or proceeding would not have a material adverse effect on the Company’s business, results of operations, financial position or liquidity.

Product Revenue Detail

Product Revenue Detail	3 Months Ended
	Mar. 31, 2020
Revenue from Contract with Customer [Abstract]
Product Revenue Detail	Product Revenue Detail MiMedx has two primary distribution channels: (1) direct to customers (healthcare professionals and/or facilities) (“ Direct Customers ”), and (2) sales through distributors (“ Distributors ”). For purposes of the required disclosure under ASC 606-10-50-5, the Company groups its customers into these two groups. This grouping by customer types does not constitute a basis for resource allocation but is information intended to provide the reader with ability to better understand how the nature, amount, timing, and uncertainty of revenue and cash flows are affected by economic factors applicable to each customer type. These groupings also do not meet the criteria under ASC 280-10-50-1 to qualify as separate operating segments. The Company did not have significant foreign operations or a single external customer from which 10% or more of revenues were derived during the three months ended March 31, 2020 and 2019. Below is a summary of net sales by each customer type (in thousands): Three Months Ended March 31, 2020 2019 Direct Customers $ 59,896 $ 64,542 Distributors 1,840 2,013 Total $ 61,736 $ 66,555

Subsequent Events

Subsequent Events	3 Months Ended
	Mar. 31, 2020
Subsequent Events [Abstract]
Subsequent Events	Subsequent Events Paycheck Protection Program (PPP) Loan On April 24, 2020, the Company received a $10.0 million loan under the Paycheck Protection Program (“ PPP ”). On May 11, 2020 the Company repaid the PPP loan. BT Loan Agreement Amendment On April 22, 2020, the Company agreed to terms for an amendment to its BT Loan Agreement with Blue Torch. The amendment provided for an increase in the maximum Total Leverage Ratio (as defined in the BT Loan Agreement), which was a quarterly test, for the remainder of 2020, and also provided for a reduction in the minimum Liquidity (as defined in the BT Loan Agreement) requirement from April 2020 through and including November 2020. Specifically, the maximum Total Leverage Ratio increased from 3.0 to 1 to 5.0 to 1 through December 31, 2020. The minimum Liquidity requirement was reduced from $40 million to $20 million for April and May 2020, and from $30 million to $20 million for June through November 2020. In connection with the amendment, the Company agreed to pay a one-time fee of approximately $0.7 million , added to the principal balance, and a 1 percentage point increase in the interest rate to LIBOR plus 9% . Sublease On April 1, 2020 the Company successfully subleased its industrial warehouse space that expires on May 31, 2023. The Company performed an asset recovery test comparing the sum of estimated undiscounted future cash flows attributable to the sublease to its carrying amount. The total undiscounted cash flows for the remaining lease term exceed the carrying amount of the asset, therefore there is no impairment. Issuance of $100 Million of Series B Convertible Preferred Stock On July 2 , 2020, the Company issued $100 million of Series B Convertible Preferred Stock to an affiliate of EW Healthcare Partners and to certain affiliates of Hayfin Capital Management LLP pursuant to that certain Securities Purchase Agreement, as described above in Note 3, “ Liquidity and Capital Resources .” $75 Million Loan Facility with Hayfin On July 2, 2020, the Company borrowed an aggregate of $50 million pursuant to the Hayfin Loan Agreement, and obtained an additional committed but undrawn $25 million facility pursuant to the Hayfin Loan Agreement, as described above in Note 3, “ Liquidity and Capital Resources .” Repayment and Termination of BT Loan Agreement On July 2, 2020, the Company repaid the remaining principal of $72.0 million , accrued interest of $0.1 million , and prepayment penalty of $1.4 million under the BT Loan Agreement with a portion of the proceeds from the Preferred Stock Transaction and the Hayfin Loan Transaction, and terminated the BT Loan Agreement, each as described above in Note 3, “ Liquidity and Capital Resources .”

Significant Accounting Polici_2

Significant Accounting Policies (Policies)	3 Months Ended
	Mar. 31, 2020
Accounting Policies [Abstract]
Segment Reporting	The Company operates in one
Basis of Presentation	Basis of Presentation The unaudited condensed consolidated financial statements have been prepared in accordance with accounting principles generally accepted in the United States of America (“ GAAP ”) from interim financial information and with the instructions to Form 10-Q and Article 10 of Regulation S-X. Accordingly, they do not include all of the information and footnotes required by GAAP for complete financial statements. Changes to GAAP are established by the Financial Accounting Standards Board (“ FASB ”) in the form of Accounting Standards Updates (“ ASU ’’) to the FASB’s Accounting Standards Codification (“ ASC ”). In the opinion of management, all adjustments (consisting of normal recurring accruals) considered necessary for a fair presentation of the results of operations for the periods presented have been included. Operating results for the three months ended March 31, 2020 and 2019 , are not necessarily indicative of the results that may be expected for the fiscal year. The balance sheet at December 31, 2019 , has been derived from the audited consolidated financial statements at that date, but does not include all of the information and footnotes required by GAAP for complete financial statements. You should read these condensed consolidated financial statements together with the historical consolidated financial statements of the Company for the year ended December 31, 2019
Use of Estimates	Use of Estimates The consolidated financial statements have been prepared in accordance with GAAP. Conformity with GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the consolidated financial statements and the reported consolidated statements of operations during the reporting period. Actual results could differ from those estimates. Significant estimates include estimated useful lives and potential impairment of property and equipment and intangible assets, estimates for contingent liabilities, management’s assessment of the Company’s ability to continue as a going concern, estimates of fair value of share-based payments and valuation of deferred tax assets.
Principles of Consolidation	Principles of Consolidation The consolidated financial statements include the accounts of MiMedx Group, Inc. and its wholly-owned subsidiaries. All intercompany balances and transactions have been eliminated upon consolidation.
Cash and Cash Equivalents	Cash and Cash Equivalents Cash and cash equivalents include cash and Federal Deposit Insurance Corporation (“ FDIC ”) insured certificates of deposit held at various banks with an original maturity of three months or less.
Accounts Receivable and Notes Receivable	Accounts Receivable Accounts receivable represent amounts due from customers for which revenue has been recognized. Generally, the Company does not require collateral or any other security to support its receivables. The allowance for doubtful accounts is the Company’s best estimate of the amount of probable credit losses in the Company’s existing receivables. The Company determines the allowance based on factors such as historical collection experience, customers’ current creditworthiness, customer concentrations, age of accounts receivable and general economic conditions that may affect customers’ ability to pay. Notes Receivable Notes receivable represent formal payment agreements with customers which generally arise in situations where amounts shipped and billed have aged significantly as well as the promissory note issued by Stability Biologics, LLC (“ Stability ”) as part of the divestiture of Stability in 2017. The promissory note from Stability was paid in full in the three months ended September 30, 2019. The Company’s notes receivable are included in other current and long-term assets in the accompanying condensed consolidated balance sheets and were valued taking into consideration cost of the market participant inputs, market conditions, liquidity, operating results and other qualitative factors.
Inventories	Inventories Inventories are valued at the lower of cost or net realizable value, using the first-in, first-out (“ FIFO ”) method. Inventory is tracked through raw material, work-in-process, and finished good stages as the product progresses through various production steps and stocking locations. Labor and overhead costs are absorbed through the various production processes until the work order closes. Historical yields and normal capacities are utilized in the calculation of production overhead rates. Reserves for inventory obsolescence are utilized to account for slow-moving inventory as well as inventory no longer needed due to diminished market demand.
Revenue Recognition	Revenue Recognition The Company sells its products primarily to individual customers and independent distributors (collectively referred to as “ customers ”). During the three months ended March 31, 2019, the Company’s control environment was such that it created uncertainty surrounding all of its customer arrangements, which required consideration related to the proper revenue recognition under the applicable literature. The control environment allowed for the existence of extra-contractual or undocumented terms or arrangements initiated by or agreed to by the Company and former members of Company management at the outset of the transactions (side agreements). Concessions were also agreed to subsequent to the initial sale (e.g. sales above established customer credit limits extended and unusually long payment terms, return or exchange rights, and contingent payment obligations) that called into question the ability to recognize revenue at the time that product was shipped to a customer. The applicable revenue recognition guidance also changed beginning January 1, 2018, which further impacted the Company’s revenue recognition methodology. As a result, the Company’s application of the applicable revenue recognition guidance varies for the three months ended March 31, 2020 and 2019. Additionally, the Company changed its pattern of revenue recognition effective October 1, 2019. The application of the relevant revenue recognition guidance and the pattern of revenue recognition are further discussed below for each period presented. Three Months Ended March 31, 2019 The Company follows ASC Topic 606, Revenue from Contracts with Customers (“ ASC 606” ) which establishes principles for reporting information about the nature, amount, timing and uncertainty of revenue and cash flows arising from the entity’s contracts to provide goods or services to customers. The core principle requires an entity to recognize revenue to depict the transfer of goods or services to customers in an amount that reflects the consideration that it expects to be entitled to receive in exchange for those goods or services recognized as performance obligations are satisfied. ASC 606 establishes a five-step model for revenue recognition. The first of these steps requires the identification of the contract as described in ASC 606-10-25-1. The specific criteria (the “ Step 1 Criteria ”) to this determination are as follows: • The parties to the contract have approved the contract (in writing, orally, or in accordance with other customary business practices) and are committed to perform their respective obligations; • The entity can identify each party’s rights regarding the goods or services to be transferred; and • The entity can identify the payment terms for the goods or services to be transferred. • The contract has commercial substance. • It is probable that the entity will collect substantially all of the consideration to which it will be entitled in exchange for the goods or services that will be transferred to the customer. For the three months ended March 31, 2019, the Company concluded that the first three of the above criteria were not met upon shipment of product to the customer, the fourth criterion had been met, and the Company acknowledges that there is a degree of uncertainty as to whether the last criterion above had been met. Although the parties to the contract may have approved the contract and purchase orders in writing, the Company concluded that upon shipment of products to the customer there is not sufficient evidence that its customers were committed to perform their obligations defined in the contract due to the existence of extra-contractual or undocumented terms or arrangements (e.g., regarding payment terms, right of return, etc.). The Company’s inability to fulfill these criteria was due to uncertainties of contractual adjustments with customers created by a combination of an inappropriate tone at the top and extra-contractual arrangements. Consequently, the Company concluded that it did not meet the Step 1 Criteria upon shipment of the product. Subsequent to the shipment of product, uncertainties surrounding contractual adjustment were not resolved until either: (1) the customer returned the product prior to payment; or (2) the Company received payment from the customer. At that point, the Company determined that an accounting contract existed and the performance obligations of the Company to deliver product and the customer to pay for the product were satisfied. The Company determined the transaction price of its contracts to equal the amount of consideration received from customers less the amount expected to be refunded or credited to customers, which is recognized as a refund liability that is updated at the end of each reporting period for changes in circumstances. The refund liability is included within accrued expenses in the consolidated balance sheet. Transition and the Three Months Ended March 31, 2020 The Company continued to assess contracts, new and existing, throughout 2019 to determine if the Step 1 Criteria noted above for the determination of a contract under ASC 606 were met for new contracts at the outset of a sales transaction (i.e., upon shipment of product) or for existing contracts at some point within 2019 when all the terms of the arrangement would have been known. Until the Step 1 Criteria had been met, revenue recognition continued to be deferred consistent with the assessment for the year ended December 31, 2018. As further discussed above, the primary factors contributing to the determination in prior periods that the Step 1 Criteria had not been met were the inappropriate tone at the top and the existence of pervasive extra-contractual or undocumented terms or arrangements. These prior business practices and the lack of transparency surrounding them created a systemically implied right for customers to demand future, unknown performance by the Company. Although some of the former executives were employed by the Company only through June 2018, the Company determined that based on the impact of the prior tone at the top, the continued internal sales force strategy and the existing customer base’s continued expectations (based on past practice), there would be flexibility with respect to arrangement terms even after delivery of the product so pervasive that all customer arrangements continued to be subject to uncertain modification of terms into 2019. After identifying the primary factors contributing to the lack of knowledge regarding its customer contractual terms, the Company began implementing changes in mid-2018 to remediate the pervasive weaknesses in the control environment, followed by gradually implementing measures to empower its compliance, legal, and accounting departments, educating its sales force on appropriate business practices, and communicating its revised terms of sale to customers. The Company assessed its efforts throughout 2019 to determine when, if at any point, the factors contributing to the inability to satisfy the Step 1 Criteria were sufficiently addressed such that the Step 1 Criteria were met at the time of physical delivery to the customer. Determining when these conditions were effectively satisfied was a matter of judgment; however, the Company determined that adequate knowledge of the contractual arrangements with its customers did exist in 2019. Management did note that there is no single determinative change that overcame the pervasive challenges noted above, but rather an accumulation of efforts that taken together, resulted in sufficient knowledge of contractual relationships both internally within the Company and externally with its customers. To address the tone at the top issues, the Company noted that proper remediation involved not only the removal of members of management that were setting an inappropriate tone but also the establishment of new management throughout the organization that emphasized a commitment to integrity, ethical values and transparency and have that reinforcement for a sustained period of time. The changes made to management positions throughout the organization and the resulting organization behavior changes were assessed to have been sufficiently addressed by mid-2019. Therefore, beginning October 1, 2019, for all new customer arrangements, the Company determined adequate measures were in place to understand the terms of its contracts with customers. As such, beginning October 1, 2019, the Company concluded that the Step 1 Criteria would be met prior to shipment of product to the customer or implantation of the products on consignment. For the remaining customer arrangements at September 30, 2019 (the “ Remaining Contracts ”), the Company concluded that due to the uncertainty that extracontractual arrangement may continue the Step 1 Criteria would not be satisfied until the Company receives payment from the customer. At that point, the Company determined that an accounting contract would exist and the performance obligations of the company to deliver product and the customer to pay for the product would be satisfied. As of March 31, 2020, upon reassessment, the Company concluded that the Step 1 Criteria continued to not be met due to the same circumstances described above. The amount related to these Remaining Contracts at March 31, 2020 was $4.5 million . Amounts Invoiced and Not Collected Deferred Cost of Sales Amounts as of December 31, 2019 $ 9,006 $ 1,261 Revenue recognized related to amounts invoiced and not collected at September 30, 2019: Cash collected during the three months ended March 31, 2020 related to the Remaining Contracts (4,495 ) (629 ) Amounts as of March 31, 2020 $ 4,511 $ 632 As a result of the reassessment as of September 30, 2019, the Company also determined that, for approximately $10.3 million of existing contracts where payment had not been received, it was not probable that substantially all consideration would be collected. For these customer contracts, the Company continued to fail the Step 1 Criteria and, therefore, no revenue was recognized in 2019. Any collections during the three months ended March 31, 2020, as well as any future collections relating to these customer contracts, will be recorded as revenue at the time payment is received. For all customer transactions concluded to meet the Step 1 Criteria, the Company then assessed the remaining criteria of ASC 606 to determine the proper timing of revenue recognition. Under ASC 606, the Company recognizes revenue following the five-step model: (i) identify the contracts with a customer (the Step 1 Criteria); (ii) identify the performance obligations in the contract; (iii) determine the transaction price; (iv) allocate the transaction price to the performance obligations in the contract; and (v) recognize revenue when (or as) the entity satisfies a performance obligation. As noted above, during the third quarter of 2019, the Company determined that they had met the Step 1 Criteria. The Company also determined that the performance obligation was met upon delivery of the product to the customer, or at the time the product is implanted for products on consignment, at which point the Company determined it will collect the consideration it is entitled to in exchange for the product transferred to the customer. As a result, the Company recognizes as revenue the amount of the transaction price that is allocated to the respective performance obligation when (or as) the performance obligation is satisfied, generally upon shipment of the product to the customer. The nature of the Company’s contracts gives rise to certain types of variable consideration, including rebates and other discounts. The Company includes estimated amounts of variable consideration in the transaction price to the extent that it is probable there will not be a significant reversal of revenue. Estimates are based on historical or anticipated performance. The Company does have consignment agreements with several customers and distributors which allow the Company to better market its products by moving them closer to the end user. In these cases, the Company determined that it has fulfilled its performance obligation once control of the product has been delivered to the customer, which occurs simultaneously with the product being implanted. The Company acts as the principal in all of its customer arrangements and therefore records revenue on a gross basis. Shipping is considered immaterial in the context of the overall customer arrangement, and damages or loss of goods in transit are rare. Therefore, shipping is not deemed a separately recognized performance obligation. The Company maintains a returns policy that allows its customers to return product that is consigned, damaged or non-conforming, ordered in error, or due to a recall. The estimate of the provision for returns is based upon historical experience with actual returns. The Company’s payment terms for customers are typically 30 to 60 days from receipt of title of the goods. Subsequent to the Transition, the Company continued to defer the cost of sales for certain arrangements for which all revenue recognition criteria have not been met. These amounts were recorded within other current assets on the consolidated balance sheet in the amount of $0.6 million and $1.3 million as of March 31, 2020 and December 31, 2019, respectively. GPO Fees The Company sells to Group Purchasing Organization (“ GPO ”) members who transact directly with the Company at GPO-agreed pricing. GPOs are funded by administrative fees that are paid by the Company. These fees are set as a percentage of the purchase volume, which is typically 3% of sales made to the GPO members. The Company presents the administrative fees paid to GPOs as a reduction of revenues because the benefit received by the Company in exchange for the GPO fees is not sufficiently separable from the GPO member’s purchase of the Company’s products. Cost of Sales Cost of sales includes all costs directly related to bringing the Company’s products to their final selling destination. Amounts include direct and indirect costs to manufacture products including raw materials, personnel costs and direct overhead expenses necessary to convert collected tissues into finished goods, product testing costs, quality assurance costs, facility costs associated with the Company’s manufacturing and warehouse facilities, depreciation, freight charges, costs to operate equipment and other shipping and handling costs for products shipped to customers.
Leases	Leases Effective January 1, 2019, the Company accounts for its leases under ASC 842, “ Leases ”. The Company determines if an arrangement is, or contains, a lease at inception. Right-of-use assets and the related liabilities result from operating leases were included in Right of use asset, Other current liabilities and Other liabilities, respectively, in the condensed consolidated balance sheets as of March 31, 2020 and December 31, 2019. Operating lease assets represent the Company’s right to use an underlying asset for the lease term and lease liabilities represent the Company’s obligation to make lease payments arising from the lease. Operating lease assets and liabilities are recognized at the lease commencement date based on the estimated present value of lease payments over the lease term. The lease term used in the calculation includes options to extend or terminate the lease when the exercise of such options are reasonably certain. The Company uses the estimated incremental borrowing rate in determining the present value of lease payments. Variable components of the lease payments such as fair market value adjustments, utilities, and maintenance costs are expensed as incurred and not included in determining the present value of lease liabilities. As an accounting policy election, the Company excludes short-term leases having initial terms of 12 months or fewer. Lease expense is recognized on a straight-line basis over the lease term. See Note 6, “ Leases ” for further information regarding lease obligations.
Patent Costs	Patent Costs
Treasury Stock	Treasury Stock The Company accounts for the purchase of treasury stock under the cost method. Treasury stock which is reissued for the exercise of option grants and the issuance of restricted stock grants is accounted for on a FIFO basis.
Recently Issued and Adopted Accounting Standards	Recently Issued Accounting Standards Adopted by the Company In February 2016, FASB issued ASU No. 2016-02, “ Leases (Topic 842) ”, which amended the guidance on accounting for leases. The FASB issued this update to increase transparency and comparability among organizations. This update requires the recognition of lease assets and lease liabilities on the balance sheet and the disclosure of key information about leasing arrangements. The Company adopted the ASU effective January 1, 2019 using the additional (optional) approach, in accordance with ASU 2018-11, “ Leases (Topic 842): Targeted Improvements .” Upon adoption, the Company recorded a right of use asset of $4.3 million and a right of use liability of $5.2 million . The right of use asset, in its entirety, is included in Right of use assets, net on the condensed consolidated balance sheet. Right of use liabilities are included in Other current liabilities to the extent that such liabilities are expected to be settled within one year and Other liabilities to the extent that such obligations are due more than one year from the balance sheet date. The difference between the right of use asset and liability relates to rent credits which existed as of January 1, 2019. There was no effect on opening retained earnings at adoption. In adopting the new lease standard, the Company elected the permitted package of practical expedients permitted, which allowed the Company to account for existing leases under their current classification, as well as omit any new costs classified as initial direct costs, under the new standard. See Note 6 for additional information on leases. In February 2018, the FASB issued ASU No. 2018-02, “ Income Statement - Reporting Comprehensive Income (Topic 220) ,” to address certain income tax effects in Accumulated Other Comprehensive Income (“ AOCI ”) resulting from the tax reform enacted in 2017. The amended guidance provides an option to reclassify tax effects within AOCI to retained earnings in the period in which the effect of the tax reform is recorded. The amendments were effective for fiscal years beginning after December 15, 2018, including interim periods. The Company adopted this ASU on January 1, 2019, which did not have any impact on the Company’s results of operations or financial condition as there were no balances in AOCI that are tax effected. In June 2018, the FASB issued ASU 2018-07, “ Compensation-Stock Compensation (Topic 718): Improvements to Non-employee Share-Based Payment Accounting ” (“ ASU 2018-07 ”), which simplifies the accounting for share-based payments to non-employees by aligning it with the accounting for share-based payments to employees, with certain exceptions. Under the new guidance, the measurement of equity-classified nonemployee awards will be fixed at the grant date. ASU 2018-07 is effective for interim and annual reporting periods beginning after December 15, 2018 and early adoption was permitted. The Company adopted the new standard on January 1, 2019. The adoption of ASU 2018-07 did not have a material impact on the Company’s consolidated financial statements and related disclosures . In June 2016, the FASB issued ASU 2016-13, “ Financial Instruments - Credit Losses (Topic 326): Measurement of Credit Losses on Financial Instruments ,” that introduces a new model for recognizing credit losses on financial instruments based on an estimate of current expected credit losses. This includes accounts receivable, trade receivables, loans, held-to-maturity debt securities, net investments in leases and certain off-balance sheet credit exposures. The guidance also modifies the impairment model for available-for-sale debt securities. The ASU is effective for fiscal years and interim periods within those fiscal years beginning after December 15, 2019. The Company adopted this ASU on January 1, 2020 using a modified retrospective transition method which requires a cumulative-effect adjustment to the opening balance of retained earnings to be recognized on the date of adoption with no change to financial results reported in prior periods. The cumulative effect adjustment recorded on January 1, 2020 is not material. The adoption of this ASU did not have a significant impact on the Company’s consolidated financial statements and related disclosures. All other ASUs issued and not yet effective for the three months ended March 31, 2020 , and through the date of this report, were assessed and determined to be either not applicable or are expected to have minimal impact on the Company’s financial position or results of operations.

Significant Accounting Polici_3

Significant Accounting Policies (Tables)	3 Months Ended
	Mar. 31, 2020
Accounting Policies [Abstract]
Assessment of Revenue under ASC 606	Amounts Invoiced and Not Collected Deferred Cost of Sales Amounts as of December 31, 2019 $ 9,006 $ 1,261 Revenue recognized related to amounts invoiced and not collected at September 30, 2019: Cash collected during the three months ended March 31, 2020 related to the Remaining Contracts (4,495 ) (629 ) Amounts as of March 31, 2020 $ 4,511 $ 632

Inventory (Tables)

Inventory (Tables)	3 Months Ended
	Mar. 31, 2020
Inventory Disclosure [Abstract]
Inventory	Inventory consisted of the following (in thousands): March 31, 2020 December 31, 2019 Raw materials $ 330 $ 318 Work in process 3,913 4,299 Finished goods 5,587 5,206 Inventory, gross 9,830 9,823 Reserve for obsolescence (583 ) (719 ) Inventory, net $ 9,247 $ 9,104

Property and Equipment (Tables)

Property and Equipment (Tables)	3 Months Ended
	Mar. 31, 2020
Property, Plant and Equipment [Abstract]
Summary of Property and Equipment	Property and equipment consisted of the following (in thousands): March 31, 2020 December 31, 2019 Leasehold improvements $ 5,321 $ 5,321 Lab and clean room equipment 15,128 14,894 Furniture and office equipment 15,405 15,118 Construction in progress 1,463 972 Property and equipment, gross 37,317 36,305 Less accumulated depreciation (25,484 ) (23,977 ) Property and equipment, net $ 11,833 $ 12,328

Leases (Tables)

Leases (Tables)	3 Months Ended
	Mar. 31, 2020
Leases [Abstract]
Supplemental Balance Sheet Information Related to Leases	Supplemental balance sheet information related to operating leases is as follows (amounts in thousands, except lease term and discount rate): March 31, 2020 December 31, 2019 Assets Right of use asset $ 3,158 $ 3,397 Liabilities Short term lease liability $ 1,195 $ 1,168 Long term lease liability $ 2,611 $ 2,919 Weighted-average remaining lease term (years) 2.8 3.1 Weighted-average discount rate 11.5 % 11.5 %
Maturities of Operating Lease Liabilities	Maturities of operating leases liabilities are as follows (amounts in thousands): Year ended December 31, Maturities 2020 (excluding the three months ended March 31, 2020) $ 1,170 2021 1,528 2022 1,552 2023 195 2024 — Thereafter — Total lease payments 4,445 Less: imputed interest (639 ) $ 3,806

Intangible Assets (Tables)

Intangible Assets (Tables)	3 Months Ended
	Mar. 31, 2020
Goodwill and Intangible Assets Disclosure [Abstract]
Intangible Assets Activity Summary - Finite Lived	Intangible assets are summarized as follows (in thousands): March 31, 2020 December 31, 2019 Gross Carrying Amount Accumulated Amortization Net Carrying Amount Gross Carrying Amount Accumulated Amortization Net Carrying Amount Amortized intangible assets Licenses $ 1,414 $ (1,234 ) $ 180 $ 1,414 $ (1,200 ) $ 214 Patents and know how 9,108 (5,232 ) 3,876 9,099 (5,070 ) 4,029 Customer and supplier relationships 3,761 (2,485 ) 1,276 3,761 (2,417 ) 1,344 Non-compete agreements 120 (75 ) 45 120 (68 ) 52 Total amortized intangible assets $ 14,403 $ (9,026 ) $ 5,377 $ 14,394 $ (8,755 ) $ 5,639 Unamortized intangible assets Trade names and trademarks $ 1,008 $ 1,008 $ 1,008 $ 1,008 Patents in process 1,196 1,196 1,130 1,130 Total intangible assets $ 16,607 $ 7,581 $ 16,532 $ 7,777
Intangible Assets Activity Summary - Indefinite Lived	Intangible assets are summarized as follows (in thousands): March 31, 2020 December 31, 2019 Gross Carrying Amount Accumulated Amortization Net Carrying Amount Gross Carrying Amount Accumulated Amortization Net Carrying Amount Amortized intangible assets Licenses $ 1,414 $ (1,234 ) $ 180 $ 1,414 $ (1,200 ) $ 214 Patents and know how 9,108 (5,232 ) 3,876 9,099 (5,070 ) 4,029 Customer and supplier relationships 3,761 (2,485 ) 1,276 3,761 (2,417 ) 1,344 Non-compete agreements 120 (75 ) 45 120 (68 ) 52 Total amortized intangible assets $ 14,403 $ (9,026 ) $ 5,377 $ 14,394 $ (8,755 ) $ 5,639 Unamortized intangible assets Trade names and trademarks $ 1,008 $ 1,008 $ 1,008 $ 1,008 Patents in process 1,196 1,196 1,130 1,130 Total intangible assets $ 16,607 $ 7,581 $ 16,532 $ 7,777
Estimated Future Amortization Expense for Intangible Assets	Expected future amortization of intangible assets as of March 31, 2020 , is as follows (in thousands): Year ending December 31, Estimated Amortization Expense 2020 (excluding the three months ended March 31, 2020) $ 739 2021 978 2022 955 2023 955 2024 955 Thereafter 795 $ 5,377

Accrued Expenses (Tables)

Accrued Expenses (Tables)	3 Months Ended
	Mar. 31, 2020
Payables and Accruals [Abstract]
Schedule of Accrued Expenses	Accrued expenses include the following (in thousands): March 31, 2020 December 31, 2019 Legal costs $ 13,302 $ 12,202 Settlement costs 5,931 5,931 Pricing adjustment settlement with Veterans Affairs 6,894 6,894 Estimated returns 1,567 2,581 External commissions 1,328 1,722 Accrued clinical trials 566 1,076 Other 1,073 1,755 Total $ 30,661 $ 32,161

Long Term Debt (Tables)

Long Term Debt (Tables)	3 Months Ended
	Mar. 31, 2020
Debt Disclosure [Abstract]
Schedule of Debt	The balances of the BT Term Loan were as follows (amounts in thousands): March 31, 2020 December 31, 2019 Current portion Long-term Current portion Long-term Liability component - principal $ 3,750 $ 68,438 $ 3,750 $ 69,375 Original issue discount — (1,723 ) — (1,890 ) Deferred financing cost — (5,078 ) — (5,579 ) Liability component - net carrying value $ 3,750 $ 61,637 $ 3,750 $ 61,906
Schedule of Interest Expense	Interest expense related to the BT Term Loan, included in Interest income (expense), net in the consolidated statements of operations, was as follows (amounts in thousands): For the Three Months Ended March 31, 2020 Interest expense - stated interest rate $ 1,840 Interest expense - amortization of original issue discount and costs 167 Interest expense - amortization of deferred financing costs 491 Total term loan interest expense $ 2,498
Future Principal Payments for the Term Loan	The future principal payments for the Company’s BT Term Loan as of March 31, 2020 were as follows (in thousands): Year ending December 31, Principal 2020 (excluding the three months ended March 31, 2020) $ 2,088 2021 3,750 2022 66,350 2023 — 2024 — Thereafter — Total Long Term Debt $ 72,188

Net Loss Per Share (Tables)

Net Loss Per Share (Tables)	3 Months Ended
	Mar. 31, 2020
Earnings Per Share [Abstract]
Computation of Basic and Diluted Net Income per Share	The following table sets forth the computation of basic and diluted net income per share (in thousands except share data): Three Months Ended March 31, 2020 2019 Net loss $ (4,821 ) $ (13,273 ) Denominator for basic earnings per share - weighted average shares 107,538,509 106,420,317 Effect of dilutive securities: Stock options, restricted stock, and warrants outstanding(a) 2,706,804 803,487 Denominator for diluted earnings per share - weighted average shares adjusted for dilutive securities 107,538,509 106,420,317 Loss per common share - basic $ (0.04 ) $ (0.12 ) Loss per common share - diluted $ (0.04 ) $ (0.12 ) (a) Securities outstanding that are included in the computation above, utilizing the treasury stock method are as follows: Three Months Ended March 31, 2020 2019 Outstanding Stock Options 919,555 609,292 Performance Based Awards 17,402 — Restricted Stock Awards 1,769,847 194,195 2,706,804 803,487
Schedule of Antidilutive Securities Excluded from Computation of Earnings Per Share	Securities outstanding that are included in the computation above, utilizing the treasury stock method are as follows: Three Months Ended March 31, 2020 2019 Outstanding Stock Options 919,555 609,292 Performance Based Awards 17,402 — Restricted Stock Awards 1,769,847 194,195 2,706,804 803,487

Supplemental Disclosure of Ca_2

Supplemental Disclosure of Cash Flow and Non-cash Investing and Financing Activities (Tables)	3 Months Ended
	Mar. 31, 2020
Supplemental Cash Flow Elements [Abstract]
Supplemental Disclosure of Cash Flow and Non-cash Investing and Financing Activities	Selected cash payments, receipts, and noncash activities are as follows (in thousands): Three Months Ended March 31, 2020 2019 Cash paid for interest $ 1,840 $ 1 Income taxes paid 6 46

Product Revenue Detail (Tables)

Product Revenue Detail (Tables)	3 Months Ended
	Mar. 31, 2020
Revenue from Contract with Customer [Abstract]
Net Sales by Customer Type	Below is a summary of net sales by each customer type (in thousands): Three Months Ended March 31, 2020 2019 Direct Customers $ 59,896 $ 64,542 Distributors 1,840 2,013 Total $ 61,736 $ 66,555

Nature of Business (Details)

Nature of Business (Details) $ in Millions	3 Months Ended
	Mar. 31, 2020USD ($)segment
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Number of business segments | segment	1
Federal income tax receivable | $	$ 11.3

Significant Accounting Polici_4

Significant Accounting Policies (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019	Dec. 31, 2019
Concentration Risk [Line Items]
Amounts Invoiced and Not Collected, After Transition Adjustment	$ 4,511		$ 9,006
Deferred Cost of Sales, After Transition Adjustment	632		1,261
Deferred cost of sales	$ 600		$ 1,300
GPO administrative fees as percent of purchase volume	3.00%
Minimum
Concentration Risk [Line Items]
Typical payment period for customers	30 days
Maximum
Concentration Risk [Line Items]
Typical payment period for customers	60 days
Patents
Concentration Risk [Line Items]
Intangible assets, net of accumulated amortization	$ 100	$ 200

Significant Accounting Polici_5

Significant Accounting Policies - Assessment of Revenue under ASC 606 (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2020	Sep. 30, 2019
Accounts Receivable, Net [Roll Forward]
Amounts Invoiced and Not Collected, beginning	$ 9,006
Proceeds from Sale and Collection of Receivables	(4,495)
Amounts Invoiced and Not Collected, ending	4,511
Deferred Cost of Sales [Roll Forward]
Deferred Cost of Sales, beginning	1,261
Deferred Cost of Sales, Cash Collected	(629)
Deferred Cost of Sales, ending	$ 632
Amounts Invoiced and Not Collected, Write-off of Deferred Costs for Customer Contracts where Collection is no Longer Reasonable Assured		$ 10,300

Significant Accounting Polici_6

Significant Accounting Policies - Recently Issued and Adopted Accounting Standards (Details) - USD ($) $ in Thousands	Jan. 01, 2019	Mar. 31, 2020	Dec. 31, 2019
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
Right of use asset		$ 3,158	$ 3,397
Lease liability		$ 3,806
ASU No. 2016-02
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
Right of use asset	$ 4,300
Lease liability	5,200
Effect on opening retained earnings	$ 0

Liquidity and Capital Resourc_2

Liquidity and Capital Resources (Details)	Jul. 02, 2020USD ($)$ / shares	May 31, 2020USD ($)	Mar. 31, 2020USD ($)$ / shares	Jun. 30, 2021	Dec. 31, 2020	Nov. 30, 2020USD ($)	Dec. 30, 2020USD ($)	May 31, 2020USD ($)	Jun. 20, 2022USD ($)	Jun. 29, 2025	Dec. 31, 2019USD ($)$ / shares
Subsequent Event [Line Items]
Cash and cash equivalents			$ 53,525,000								$ 69,069,000
Total current assets			115,888,000								123,245,000
Total current liabilities			$ 63,699,000								$ 67,322,000
Preferred stock par value (in dollars per share) | $ / shares			$ 0.001								$ 0.001
Subsequent Event | Series B Convertible Preferred Stock
Subsequent Event [Line Items]
Stock issued during period	$ 100,000,000
Preferred stock par value (in dollars per share) | $ / shares	$ 0.001
Proceeds from issuance of convertible preferred stock	$ 100,000,000
BT Loan Agreement | Term Loan | Subsequent Event
Subsequent Event [Line Items]
Repayment of principal	72,000,000
Accrued interest paid	100,000
Prepayment of premium paid	1,400,000
Hayfin Loan Agreement Term Loan | Senior secured term loan | Subsequent Event
Subsequent Event [Line Items]
Face value of debt	50,000,000
Hayfin Loan Agreement Delayed Draw Term Loan | Term Loan | Subsequent Event
Subsequent Event [Line Items]
Face value of debt	$ 25,000,000
Commitment fee on undrawn amounts (percent)	1.00%
Total net leverage ratio	3.5
Hayfin Loan Agreement | Senior secured term loan | Subsequent Event
Subsequent Event [Line Items]
Upfront commitment fee (percent)	2.00%
Cap on cash netting for calculation of Total Net Leverage	$ 10,000,000
Minimum liquidity	$ 10,000,000
LIBOR | BT Loan Agreement | Term Loan
Subsequent Event [Line Items]
Basis spread on variable rate			8.00%
LIBOR | Hayfin Loan Agreement | Senior secured term loan | Subsequent Event
Subsequent Event [Line Items]
Floor interest rate (percent)	1.50%
Basis spread on variable rate	6.75%
Minimum | LIBOR | Hayfin Loan Agreement | Senior secured term loan | Subsequent Event
Subsequent Event [Line Items]
Basis spread on variable rate, based on total net leverage levels (percent)	6.50%
Maximum | LIBOR | Hayfin Loan Agreement | Senior secured term loan | Subsequent Event
Subsequent Event [Line Items]
Basis spread on variable rate, based on total net leverage levels (percent)	6.00%
Forecast | BT Loan Agreement | Term Loan
Subsequent Event [Line Items]
Minimum liquidity		$ 40,000,000				$ 30,000,000	$ 30,000,000	$ 40,000,000	$ 20,000,000
Forecast | Hayfin Loan Agreement | Senior secured term loan
Subsequent Event [Line Items]
Total net leverage ratio				4.5	5					4

Inventory (Details)

Inventory (Details) - USD ($) $ in Thousands	Mar. 31, 2020	Dec. 31, 2019
Inventory Disclosure [Abstract]
Raw materials	$ 330	$ 318
Work in process	3,913	4,299
Finished goods	5,587	5,206
Inventory, gross	9,830	9,823
Reserve for obsolescence	(583)	(719)
Inventory, net	$ 9,247	$ 9,104

Property and Equipment - Summar

Property and Equipment - Summary of Property and Equipment (Details) - USD ($) $ in Thousands	Mar. 31, 2020	Dec. 31, 2019
Property, Plant and Equipment [Line Items]
Property and equipment, gross	$ 37,317	$ 36,305
Less accumulated depreciation	(25,484)	(23,977)
Property and equipment, net	11,833	12,328
Leasehold improvements
Property, Plant and Equipment [Line Items]
Property and equipment, gross	5,321	5,321
Lab and clean room equipment
Property, Plant and Equipment [Line Items]
Property and equipment, gross	15,128	14,894
Furniture and office equipment
Property, Plant and Equipment [Line Items]
Property and equipment, gross	15,405	15,118
Construction in progress
Property, Plant and Equipment [Line Items]
Property and equipment, gross	$ 1,463	$ 972

Property and Equipment - Narrat

Property and Equipment - Narrative (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019
Property, Plant and Equipment [Abstract]
Depreciation	$ 1,506	$ 1,695

Leases - Narrative (Details)

Leases - Narrative (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019
Leases [Abstract]
Operating lease cost	$ 400
Interest on lease obligations	100
Cash paid for amounts included in the measurement of operating lease liabilities	400
Amortization of right of use assets	$ 239	$ 269

Leases - Supplemental Balance S

Leases - Supplemental Balance Sheet Information (Details) - USD ($) $ in Thousands	Mar. 31, 2020	Dec. 31, 2019
Leases [Abstract]
Right of use asset	$ 3,158	$ 3,397
Short term lease liability	1,195	1,168
Long term lease liability	$ 2,611	$ 2,919
Weighted-average remaining lease term (years)	2 years 9 months 18 days	3 years 1 month 6 days
Weighted-average discount rate	11.50%	11.50%

Leases - Maturities of Operatin

Leases - Maturities of Operating Lease Liabilities (Details) $ in Thousands	Mar. 31, 2020USD ($)
Leases [Abstract]
2020 (excluding the three months ended March 31, 2020)	$ 1,170
2021	1,528
2022	1,552
2023	195
2024	0
Thereafter	0
Total lease payments	4,445
Less: imputed interest	(639)
Lease liabilities	$ 3,806

Intangible Assets - Summary of

Intangible Assets - Summary of Intangible Assets (Details) - USD ($) $ in Thousands	Mar. 31, 2020	Dec. 31, 2019
Schedule of Finite And Indefinite-Lived Intangible Assets [Line Items]
Gross carrying amount, amortized intangible assets	$ 14,403	$ 14,394
Accumulated amortization, amortized intangible assets	(9,026)	(8,755)
Net carrying amount, amortized intangible assets	5,377	5,639
Total	16,607	16,532
Net	7,581	7,777
Tradenames & Trademarks
Schedule of Finite And Indefinite-Lived Intangible Assets [Line Items]
Carrying amount, unamortized intangible assets	1,008	1,008
Patents in Process
Schedule of Finite And Indefinite-Lived Intangible Assets [Line Items]
Carrying amount, unamortized intangible assets	1,196	1,130
Licenses
Schedule of Finite And Indefinite-Lived Intangible Assets [Line Items]
Gross carrying amount, amortized intangible assets	1,414	1,414
Accumulated amortization, amortized intangible assets	(1,234)	(1,200)
Net carrying amount, amortized intangible assets	180	214
Patents & Know How
Schedule of Finite And Indefinite-Lived Intangible Assets [Line Items]
Gross carrying amount, amortized intangible assets	9,108	9,099
Accumulated amortization, amortized intangible assets	(5,232)	(5,070)
Net carrying amount, amortized intangible assets	3,876	4,029
Customer & Supplier Relationships
Schedule of Finite And Indefinite-Lived Intangible Assets [Line Items]
Gross carrying amount, amortized intangible assets	3,761	3,761
Accumulated amortization, amortized intangible assets	(2,485)	(2,417)
Net carrying amount, amortized intangible assets	1,276	1,344
Non-compete agreements
Schedule of Finite And Indefinite-Lived Intangible Assets [Line Items]
Gross carrying amount, amortized intangible assets	120	120
Accumulated amortization, amortized intangible assets	(75)	(68)
Net carrying amount, amortized intangible assets	$ 45	$ 52

Intangible Assets - Narrative (

Intangible Assets - Narrative (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019
Goodwill and Intangible Assets Disclosure [Abstract]
Amortization of intangible assets	$ 271	$ 233

Intangible Assets - Estimated F

Intangible Assets - Estimated Future Amortization Expense for Intangible Assets (Details) - USD ($) $ in Thousands	Mar. 31, 2020	Dec. 31, 2019
Estimated Amortization Expense
2020 (excluding the three months ended March 31, 2020)	$ 739
2021	978
2022	955
2023	955
2024	955
Thereafter	795
Net carrying amount, amortized intangible assets	$ 5,377	$ 5,639

Accrued Expenses (Details)

Accrued Expenses (Details) - USD ($) $ in Thousands	Mar. 31, 2020	Dec. 31, 2019
Payables and Accruals [Abstract]
Legal costs	$ 13,302	$ 12,202
Settlement costs	5,931	5,931
Pricing adjustment settlement with Veterans Affairs	6,894	6,894
Estimated returns	1,567	2,581
External commissions	1,328	1,722
Accrued clinical trials	566	1,076
Other	1,073	1,755
Total	$ 30,661	$ 32,161

Long Term Debt (Details)

Long Term Debt (Details) - Term Loan - BT Loan Agreement	Jun. 10, 2019USD ($)	May 31, 2020USD ($)	Mar. 31, 2020USD ($)	Nov. 30, 2020USD ($)	Dec. 30, 2020USD ($)	Jun. 10, 2021	Jun. 10, 2020	May 31, 2020USD ($)	Jun. 20, 2022USD ($)	Dec. 31, 2020
Debt Instrument [Line Items]
Quarterly installments	$ 900,000
Original issue discount	2,300,000
Deferred financing costs	$ 6,700,000
Stated interest rate (percent)	10.46%		9.95%
Total leverage ratio	3
Fair value of term loan			$ 62,700,000
LIBOR
Debt Instrument [Line Items]
Basis spread on variable rate			8.00%
Forecast
Debt Instrument [Line Items]
Total leverage ratio										2.50
Minimum liquidity		$ 40,000,000		$ 30,000,000	$ 30,000,000			$ 40,000,000	$ 20,000,000
Prepayment penalty as percent of prepaid principal						2.00%	3.00%

Long Term Debt - Term Loan Bala

Long Term Debt - Term Loan Balances (Details) - USD ($) $ in Thousands	Mar. 31, 2020	Dec. 31, 2019
Current portion
Liability component - principal	$ 3,750	$ 3,750
Original issue discount	0	0
Deferred financing cost	0	0
Liability component - net carrying value	3,750	3,750
Long-term
Liability component - principal	68,438	69,375
Original issue discount	(1,723)	(1,890)
Deferred financing cost	(5,078)	(5,579)
Liability component - net carrying value	$ 61,637	$ 61,906

Long Term Debt - Term Loan Inte

Long Term Debt - Term Loan Interest Expense (Details) - Term Loan - BT Loan Agreement $ in Thousands	3 Months Ended
	Mar. 31, 2020USD ($)
Debt Instrument [Line Items]
Interest expense - stated interest rate	$ 1,840
Interest expense - amortization of original issue discount and costs	167
Interest expense - amortization of deferred financing costs	491
Total term loan interest expense	$ 2,498

Long Term Debt - Term Loan Matu

Long Term Debt - Term Loan Maturity (Details) $ in Thousands	Mar. 31, 2020USD ($)
Debt Disclosure [Abstract]
2020 (excluding the three months ended March 31, 2020)	$ 2,088
2021	3,750
2022	66,350
2023	0
2024	0
Thereafter	0
Total Long Term Debt	$ 72,188

Long Term Debt - Subsequent Act

Long Term Debt - Subsequent Activity (Details) - USD ($)	2 Months Ended	3 Months Ended	6 Months Ended	7 Months Ended	12 Months Ended	18 Months Ended
	May 31, 2020	Mar. 31, 2020	Nov. 30, 2020	Dec. 30, 2020	May 31, 2020	Jun. 20, 2022	Jul. 02, 2020
Term Loan | BT Loan Agreement | LIBOR
Debt Instrument [Line Items]
Basis spread on variable rate		8.00%
Subsequent Event | Term Loan | Hayfin Loan Agreement Delayed Draw Term Loan
Debt Instrument [Line Items]
Face value of debt							$ 25,000,000
Subsequent Event | Senior secured term loan | Hayfin Loan Agreement Term Loan
Debt Instrument [Line Items]
Face value of debt							$ 50,000,000
Forecast | Term Loan | BT Loan Agreement
Debt Instrument [Line Items]
Minimum liquidity	$ 40,000,000		$ 30,000,000	$ 30,000,000	$ 40,000,000	$ 20,000,000

Net Loss Per Share (Details)

Net Loss Per Share (Details) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019
Computation of basic and diluted net loss per share [Abstract]
Net loss	$ (4,821)	$ (13,273)
Denominator for basic earnings per share - weighted average shares (in shares)	107,538,509	106,420,317
Effect of dilutive securities: Stock options, restricted stock, and warrants outstanding (in shares)	2,706,804	803,487
Denominator for diluted earnings per share - weighted average shares adjusted for dilutive securities (in shares)	107,538,509	106,420,317
Loss per common share - basic (in dollars per share)	$ (0.04)	$ (0.12)
Loss per common share - diluted (in dollars per share)	$ (0.04)	$ (0.12)
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive securities excluded from computation of earnings per share (in shares)	2,706,804	803,487
Outstanding Stock Options
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive securities excluded from computation of earnings per share (in shares)	919,555	609,292
Performance Based Awards
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive securities excluded from computation of earnings per share (in shares)	17,402	0
Restricted Stock Awards
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive securities excluded from computation of earnings per share (in shares)	1,769,847	194,195

Income Taxes (Details)

Income Taxes (Details) - USD ($)	3 Months Ended		12 Months Ended
	Mar. 31, 2020	Mar. 31, 2019	Dec. 31, 2020
Income Tax Contingency [Line Items]
Effective tax rate	(70.10%)	0.30%
Effective income tax rate reconciliation, discrete items	$ 0	$ 11,400,000
Federal income tax receivable	11,300,000
Tax benefit recognized with respect to net operating losses	$ 0
Forecast
Income Tax Contingency [Line Items]
Effective tax rate			(0.60%)

Supplemental Disclosure of Ca_3

Supplemental Disclosure of Cash Flow and Non-cash Investing and Financing Activities (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019
Supplemental disclosure of cash flow and non-cash investing and financing activities [Abstract]
Cash paid for interest	$ 1,840	$ 1
Income taxes paid	$ 6	$ 46

Contractual Commitments and C_2

Contractual Commitments and Contingencies - Narrative (Details) $ in Millions	Jan. 16, 2019lawsuit	Jan. 31, 2019	May 31, 2018former_employee	Mar. 31, 2020USD ($)former_employee	Mar. 31, 2019USD ($)	Jun. 30, 2020USD ($)	Dec. 06, 2018lawsuit
Loss Contingencies [Line Items]
Rent expense				$ 0.3	$ 0.4
Estimated litigation liability				12.8
Payments for legal settlements				$ 9.2
Shareholder Derivative Suits
Loss Contingencies [Line Items]
Number of shareholder derivative actions | lawsuit							3
Securities Class Action
Loss Contingencies [Line Items]
Number of class actions | lawsuit	2
Department of Veterans' Affairs Office of the Inspector General's Investigation
Loss Contingencies [Line Items]
Number of former VA employees | former_employee			3
Prosecution deferral period		18 months
Number of former VA employees who completed the pretrial diversion program | former_employee				2
Minimum
Loss Contingencies [Line Items]
Lease expiration period				3 years
Maximum
Loss Contingencies [Line Items]
Lease expiration period				3 years 6 months
Subsequent Event | Former Chief Financial Officer
Loss Contingencies [Line Items]
Severance costs						$ 4

Product Revenue Detail (Details

Product Revenue Detail (Details) $ in Thousands	3 Months Ended
	Mar. 31, 2020USD ($)distribution_channel	Mar. 31, 2019USD ($)
Disaggregation of Revenue [Line Items]
Number of primary distribution channels | distribution_channel	2
Net sales	$ 61,736	$ 66,555
Direct Customers
Disaggregation of Revenue [Line Items]
Net sales	59,896	64,542
Distributors
Disaggregation of Revenue [Line Items]
Net sales	$ 1,840	$ 2,013

Subsequent Events (Details)

Subsequent Events (Details)

Jul. 02, 2020USD ($)

Apr. 22, 2020USD ($)

Apr. 01, 2020USD ($)

May 31, 2020USD ($)

Mar. 31, 2020

Nov. 30, 2020USD ($)

Dec. 30, 2020USD ($)

May 31, 2020USD ($)

Jun. 20, 2022USD ($)

Dec. 31, 2020

Mar. 27, 2020USD ($)

Jun. 10, 2019USD ($)

Subsequent Event

Subsequent Event [Line Items]

Operating lease, impairment loss

$ 0

BT Loan Agreement | Subsequent Event

Subsequent Event [Line Items]

Total leverage ratio

3

Amended Term Loan Agreement | Subsequent Event

Subsequent Event [Line Items]

Total leverage ratio

5

Paycheck Protection Program Loan

Subsequent Event [Line Items]

Face value of debt

$ 10,000,000

Term Loan | BT Loan Agreement

Subsequent Event [Line Items]

Total leverage ratio

3

Deferred financing costs

$ 6,700,000

Term Loan | BT Loan Agreement | Subsequent Event

Subsequent Event [Line Items]

Repayment of principal

$ 72,000,000

Accrued interest paid

100,000

Prepayment of premium paid

1,400,000

Term Loan | Amended Term Loan Agreement | Subsequent Event

Subsequent Event [Line Items]

Deferred financing costs

$ 700,000

Term Loan | Hayfin Loan Agreement Delayed Draw Term Loan | Subsequent Event

Subsequent Event [Line Items]

Face value of debt

25,000,000

Senior secured term loan | Hayfin Loan Agreement Term Loan | Subsequent Event

Subsequent Event [Line Items]

Face value of debt

50,000,000

Forecast | Term Loan | BT Loan Agreement

Subsequent Event [Line Items]

Total leverage ratio

2.50

Minimum liquidity

$ 40,000,000

$ 30,000,000

$ 30,000,000

$ 40,000,000

$ 20,000,000

Forecast | Term Loan | Amended Term Loan Agreement

Subsequent Event [Line Items]

Minimum liquidity

$ 20,000,000

$ 20,000,000

LIBOR | Term Loan | BT Loan Agreement

Subsequent Event [Line Items]

Basis spread on variable rate

8.00%

LIBOR | Term Loan | Amended Term Loan Agreement | Subsequent Event

Subsequent Event [Line Items]

Increase in interest rate (percent)

1.00%

Basis spread on variable rate

9.00%

Series B Convertible Preferred Stock | Subsequent Event

Subsequent Event [Line Items]

Stock issued during period

$ 100,000,000