MiMedx (MDXG) 10-Q 28 Apr 21 2021 Q1 Quarterly report Financial data

Cover

Cover - shares	3 Months Ended
	Mar. 31, 2021	Apr. 16, 2021
Cover [Abstract]
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Mar. 31, 2021
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
Title of 12(b) Security	Common Stock, par value $0.001 per share
Trading Symbol	MDXG
Security Exchange Name	NASDAQ
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	false
Entity Shell Company	false
Entity Common Stock, Shares Outstanding		111,718,544
Entity Central Index Key	0001376339
Current Fiscal Year End Date	--12-31
Document Fiscal Year Focus	2021
Document Fiscal Period Focus	Q1
Amendment Flag	false

CONDENSED CONSOLIDATED BALANCE

CONDENSED CONSOLIDATED BALANCE SHEETS - USD ($) $ in Thousands	Mar. 31, 2021	Dec. 31, 2020
Current assets:
Cash and cash equivalents	$ 84,746	$ 95,812
Accounts receivable, net	35,420	35,423
Inventory	11,582	10,361
Prepaid expenses	4,695	5,605
Income tax receivable	9,991	10,045
Other current assets	3,530	3,371
Total current assets	149,964	160,617
Property and equipment, net	11,044	11,437
Right of use asset	3,567	3,623
Goodwill	19,976	19,976
Intangible assets, net	5,918	6,004
Other assets	344	375
Total assets	190,813	202,032
Current liabilities:
Accounts payable	6,925	8,765
Accrued compensation	16,153	18,467
Accrued expenses	30,676	30,460
Other current liabilities	1,657	1,470
Total current liabilities	55,411	59,162
Long term debt, net	47,799	47,697
Other liabilities	3,624	3,755
Total liabilities	106,834	110,614
Commitments and contingencies (Note 13)
Convertible preferred stock Series B; $0.001 par value; 100,000 shares authorized, issued and outstanding at March 31, 2021 and December 31, 2020	92,030	91,568
Stockholders' deficit
Preferred stock Series A; $0.001 par value; 5,000,000 shares authorized, 0 issued and outstanding at March 31, 2021 and December 31, 2020	0	0
Common stock; $0.001 par value; 187,500,000 shares authorized; 112,703,926 issued and 111,620,629 outstanding at March 31, 2021 and 112,703,926 issued and 110,930,243 outstanding at December 31, 2020	113	113
Additional paid-in capital	156,733	158,610
Treasury stock at cost; 1,083,297 shares at March 31, 2021 and 1,773,683 shares at December 31, 2020	(5,091)	(7,449)
Accumulated deficit	(159,806)	(151,424)
Total stockholders' deficit	(8,051)	(150)
Total liabilities, convertible preferred stock, and stockholders’ deficit	$ 190,813	$ 202,032

CONDENSED CONSOLIDATED BALANC_2

CONDENSED CONSOLIDATED BALANCE SHEETS (Parenthetical) - $ / shares	Mar. 31, 2021	Dec. 31, 2020
LIABILITIES, CONVERTIBLE PREFERRED STOCK, AND STOCKHOLDERS’ DEFICIT
Series B convertible preferred stock par value (in dollars per share)	$ 0.001	$ 0.001
Series B convertible preferred stock, shares authorized (in shares)	100,000	100,000
Series B convertible preferred stock, shares issued (in shares)	100,000	100,000
Series B convertible preferred stock, shares outstanding (in shares)	100,000	100,000
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)	187,500,000
Common stock, shares issued (in shares)	112,703,926	112,703,926
Common stock, shares outstanding (in shares)	111,620,629	110,930,243
Treasury stock, shares (in shares)	1,083,297	1,773,683

CONDENSED CONSOLIDATED STATEMEN

CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Income Statement [Abstract]
Net sales	$ 59,967	$ 61,736
Cost of sales	9,641	10,025
Gross profit	50,326	51,711
Operating expenses:
Selling, general and administrative	45,404	46,942
Investigation, restatement and related	7,196	15,592
Research and development	4,339	2,650
Amortization of intangible assets	239	271
Operating loss	(6,852)	(13,744)
Other expense, net
Interest expense, net	(1,472)	(2,387)
Other income, net	0	6
Loss before income tax provision	(8,324)	(16,125)
Income tax provision (expense) benefit	(58)	11,304
Net loss	(8,382)	(4,821)
Net loss available to common stockholders (Note 9)	$ (9,850)	$ (4,821)
Net loss per common share - basic (in dollars per share)	$ (0.09)	$ (0.04)
Net loss per common share - diluted (in dollars per share)	$ (0.09)	$ (0.04)
Weighted average common shares outstanding - basic (in shares)	109,401,383	107,538,509
Weighted average common shares outstanding - diluted (in shares)	109,401,383	107,538,509

CONDENSED CONSOLIDATED STATEM_2

CONDENSED CONSOLIDATED STATEMENTS OF STOCKHOLDERS' DEFICIT - USD ($) $ in Thousands	Total	Common Stock Issued	Additional Paid-in Capital	Treasury Stock	Accumulated Deficit
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	298		(1,214)	$ 1,512
Exercise of stock options (in shares)				(170,300)
Restricted stock canceled/forfeited	0		1,746	$ (1,746)
Restricted stock canceled/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)
Balance (in shares) at Dec. 31, 2020		112,703,926		1,773,683
Balance, beginning of period at Dec. 31, 2020	(150)	$ 113	158,610	$ (7,449)	(151,424)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Deemed dividends	(462)		(462)
Share-based compensation expense	3,244		3,244
Exercise of stock options	$ 915		(1,364)	$ 2,279
Exercise of stock options (in shares)	(352,623)			(310,813)
Issuance of restricted stock	$ 0		(3,596)	$ 3,596
Issuance of restricted stock (in shares)				(742,001)
Restricted stock canceled/forfeited	0		301	$ (301)
Restricted stock canceled/forfeited (in shares)				35,589
Shares repurchased for tax withholding (in shares)				326,839
Shares repurchased for tax withholding	(3,216)			$ (3,216)
Net loss	(8,382)				(8,382)
Balance (in shares) at Mar. 31, 2021		112,703,926		1,083,297
Balance, end of period at Mar. 31, 2021	$ (8,051)	$ 113	$ 156,733	$ (5,091)	$ (159,806)

CONDENSED CONSOLIDATED STATEM_3

CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Cash flows from operating activities:
Net loss	$ (8,382)	$ (4,821)
Adjustments to reconcile net loss to net cash flows used in operating activities:
Share-based compensation	3,244	3,349
Depreciation	1,161	1,506
Amortization of intangible assets	239	271
Amortization of deferred financing costs	415	668
Non-cash lease expenses	237	239
Accretion of asset retirement obligation	17	0
Loss on fixed asset disposal	236	0
Increase (decrease) in cash resulting from changes in:
Accounts receivable	3	395
Inventory	(1,221)	(143)
Prepaid expenses	910	1,430
Income taxes	54	(10,711)
Other assets	319	812
Accounts payable	(936)	1,046
Accrued compensation	(2,314)	(4,186)
Accrued expenses	(484)	(2,845)
Other liabilities	(177)	709
Net cash flows used in operating activities	(6,679)	(12,281)
Cash flows from investing activities:
Purchases of equipment	(1,941)	(1,011)
Principal payments from note receivable	15	0
Patent application costs	(153)	(75)
Net cash flows used in investing activities	(2,079)	(1,086)
Cash flows from financing activities:
Proceeds from exercise of stock options	915	298
Stock repurchased for tax withholdings on vesting of restricted stock	(3,216)	(1,538)
Principal payments on finance lease	(7)	0
Repayment of term loans	0	(937)
Net cash flows used in financing activities	(2,308)	(2,177)
Net change in cash	(11,066)	(15,544)
Cash and cash equivalents, beginning of period	95,812	69,069
Cash and cash equivalents, end of period	$ 84,746	$ 53,525

Nature of Business

Nature of Business	3 Months Ended
	Mar. 31, 2021
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 industry leader in utilizing amniotic tissue as a platform for regenerative medicine, developing and distributing placental tissue allografts with patent-protected, proprietary processes for multiple sectors of healthcare. As a pioneer in placental biologics, MiMedx has both a core business, focused on addressing the needs of patients with acute and chronic non-healing wounds, and a promising late-state pipeline targeted at decreasing pain and improving function for patients with degenerative musculoskeletal conditions. The Company derives its products from human placental tissues and process these tissues using our proprietary methods, including the PURION® process. MiMedx employs Current Good Tissue Practices, Current Good Manufacturing Practices, and terminal sterilization to produce its allografts. MiMedx provides products primarily in the wound care, burn, surgical, and non-operative sports medicine sectors of healthcare. All of its products are regulated by the United State Food and Drug Administration (“ FDA ”). The Company’s business model is focused primarily on the United States of America but the Company is pursuing opportunities for international expansion. Effect of Covid-19 Pandemic On March 11, 2020, the World Health Organization designated the outbreak of a novel strain of coronavirus (“ Covid-19 ”) as a global pandemic (the “ Pandemic ” or “ Covid-19 Pandemic ”).The Covid-19 Pandemic and associated governmental and societal responses 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. As a result of the Pandemic, the Company has experienced delays and impacts on its business and clinical trials. It is uncertain the extent and how long the Pandemic will affect the healthcare system and the global economy as a whole. The effects of the Pandemic or other health epidemics could continue to have an adverse impact on the Company’s business, results of operations and financial condition in the future. 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 businesses, 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, of which $1.2 million has been collected. The income tax benefit was recognized due to the release of a previously-recorded valuation allowance. Of this amount, $10.1 million was recorded as part of income tax receivable on the unaudited condensed consolidated balance sheets as of both March 31, 2021 and December 31, 2020. Liquidity and Capital Resources The Company has analyzed its ability to address commitments and potential liabilities for the 12 months extending from the date of the filing of this Quarterly Report, including the full impact of enforcement discretion. The Company believes that its anticipated cash from operating activities, after the anticipated negative effects from the conclusion of the FDA’s enforcement discretion effective May 31, 2021, and existing cash and cash equivalents will enable it to meet our operational liquidity needs for the twelve months following the issuance of this Quarterly Report on Form 10-Q (“ Quarterly Report ”).

Significant Accounting Policies

Significant Accounting Policies	3 Months Ended
	Mar. 31, 2021
Accounting Policies [Abstract]
Significant Accounting Policies	Significant Accounting Policies Please see Note 2 to the Company’s Consolidated Financial Statements included in the Company’s Annual Report on Form 10-K for the year ended December 31, 2020, filed with the Securities and Exchange Commission (“ SEC ”) on March 8, 2021 (the “ 2020 Form 10-K ”) 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. 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. The operating results for the three months ended March 31, 2021 and 2020 are not necessarily indicative of the results that may be expected for the fiscal year. The balance sheet as of December 31, 2020 was 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. These financial statements reflect all adjustments which are, in the opinion of management, necessary to a fair statement of the results for the interim periods presented. These unaudited condensed consolidated financial statements should be read in conjunction with the historical consolidated financial statements of the Company included in the 2020 Form 10-K. Use of Estimates The unaudited condensed 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 unaudited condensed consolidated financial statements and the reported unaudited condensed 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 regarding asset retirement obligations, estimates for contingent liabilities, the measurement of right-of-use assets and lease 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. In addition to the above, the Company has considered the potential effects of the Covid-19 Pandemic with respect to its determinations surrounding impairments, increases in allowances for credit losses, other expenses, and changes in accounting judgments that have or are reasonably likely to have a material impact on the unaudited condensed consolidated financial statements. Principles of Consolidation The unaudited condensed 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 held at various banks. The Company considers all highly-liquid investments purchased with an original maturity of three months or less at the date of purchase and money market mutual funds to be cash equivalents. 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. Bad debt expense and the allowance for doubtful accounts are based on historical trends and current expectations for credit losses and reasonable and supportable forecasts. The Company’s policy to reserve for potential bad debts is based on the aging of the individual receivables as well as customer-specific qualitative factors, such as bankruptcy proceedings. The Company manages credit risk by routinely performing credit checks on customers prior to sales. The individual receivables are written-off after all reasonable efforts to collect the funds have been made. Actual write-offs may differ from the amounts reserved. The Company’s allowance for doubtful accounts was $0.7 million as of both March 31, 2021 and December 31, 2020. 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. Slow moving and obsolete inventory that is no longer needed due to diminished market demand is presented at the lower of cost or net realizable value. Goodwill Goodwill represents the excess of purchase price over the fair value of net assets of acquired businesses. The Company assesses the recoverability of its goodwill at least annually on October 1 and whenever events or substantive changes in circumstances indicate that the asset may be impaired. The Company may first choose to assess qualitative factors to determine whether it is more likely than not that the fair value of a reporting unit is less than its carrying amount. If the Company determines that it is more likely than not that the fair value of a reporting unit is less than its carrying amount, then the Company performs a quantitative analysis. The Company may also choose to bypass the qualitative assessment and proceed directly to the quantitative analysis. As of March 31, 2021, the Company concluded it operates as one reporting unit. Under the quantitative test, if the carrying value of the reporting unit exceeds its fair value, goodwill impairment is recognized for the amount that the carrying value exceeds fair value, not to exceed the total amount of goodwill allocated to the reporting unit. The Company determines fair value using income and market approaches. Under the income approach, the fair value of the Company is the present value of its future economic benefits. These benefits can include revenue, cost savings, tax deductions, and proceeds from its disposition. Value indications are developed by discounting expected cash flows to their present value at a rate of return that incorporates the risk-free rate for the use of funds, industry trends, and entity-specific risks as of the goodwill impairment testing date. Under the market approach, the Company uses observed fair values of a set of companies with comparable business models to the reporting unit under evaluation for purposes of determining the fair value of the reporting unit. These amounts are reconciled to the Company’s market capitalization as of the test date for reasonableness. Change in Annual Goodwill Impairment Testing Date The Company elected to change its annual goodwill and indefinite-lived intangible asset impairment testing date from September 30 to October 1. The change in the annual impairment testing date provides the Company with more time in identifying and calculating any impairments and to maximize the use of the Company’s available resources. Because GAAP does not permit more than 12 months to pass between annual goodwill impairment tests, the Company performed quantitative tests on September 30 and October 1, 2020. As a result of each of these tests, the Company concluded that the fair value of the reporting unit exceeded the carrying value and recorded no impairment. Revenue Recognition The Company sells its products primarily to individual customers and independent distributors (collectively referred to as “ customers ”). Customers obtain and use products either through ship and bill arrangements or consignment arrangements. Under ship and bill arrangements, the customer submits an order. Upon approval of the sales order, the Company ships product to the customer and invoices them for the product sold. Under consignment arrangements, the customer takes possession of the product, but the Company retains title until the implantation, or application of the Company’s product to the end user. The Company recognizes revenue as performance obligations are fulfilled; which occurs upon the shipment of product to the customers for ship and bill orders or upon implantation for consignment sales. Revenue is recognized based on consideration the Company expects to be entitled to from the sale. This consists of the gross selling price of the product, less any discounts or rebates (collectively, “ deductions ” or “ sales deductions ”). Gross selling price is a standard set by the Company for all customers unless a contract governing the sale provides for a specified price. Sales deductions are specified in individual contracts with customers and are generally achieved based on total sales during a specified period. The Company estimates the total sales deductions that a specific customer will achieve over the relevant term and applies the reduction to sales as they are made throughout the period. Rebates owed to customers are accrued and recorded in accrued expenses on the unaudited condensed consolidated balance sheets. The Company acts as principal in all of its customer arrangements and 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 and the Company has elected to treat shipping costs as activities to fulfill the promise to transfer the product. 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 on 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. In addition to the above revenue recognition policy, the Company recognizes revenue from customers with balances outstanding as of September 30, 2019 for which all of the criteria necessary for revenue recognition were not met at the time of shipment and that such criteria would not be met until collection of such sales (the “ Remaining Contracts ”). This was in accordance with the change in the Company’s revenue recognition pattern beginning September 30, 2019 (the “ Transition ”). A summary of the effects of cash collections on the Remaining Contracts on the unaudited condensed consolidated statements of operations for each of the three months ended March 31, 2021 and 2020 are as follows (amounts in thousands): Three months ended March 31, 2021 2020 Net sales $ 298 $ 4,495 Cost of sales 42 629 Gross profit $ 256 $ 3,866 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. The Company defers the recognition of cost of sales associated with the Remaining Contracts until revenue is recognized and cash is collected. Amounts related to amount on the Remaining Contracts outstanding are recorded as part of other current assets on the unaudited condensed consolidated balance sheets. Deferred cost of sales were $0.1 million and $0.2 million as of March 31, 2021 and December 31, 2020, respectively. 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, which were included in Right of use asset, Other current liabilities and Other liabilities, respectively. As of March 31, 2021, the Company has both finance and operating leases. 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. 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 determination of whether the Company is reasonably certain to exercise a renewal or termination option is reassessed as new information arises and is accounted for prospectively as of the point in time the determination is made regarding the modification of the lease term. The Company uses its 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. For operating leases, lease expense is recognized on a straight-line basis over the lease term through selling, general and administrative expense on the unaudited condensed consolidated statements of operations. For finance leases, the right of use asset is amortized, straight-line, over the life of the lease as depreciation expense, which is included as a component of through selling, general and administrative expense on the unaudited condensed consolidated statements of operations. The Company recognizes interest expense on finance lease liabilities based on the incremental borrowing rate at lease inception applied to the outstanding right of use liability. The Company does not recognize interest expense on operating lease liabilities. Payments on operating leases are considered cash flows from operating activities. Payments on finance leases, to the extent that the payment relates to the reduction of the principal balance of the liability, are considered cash flows from financing activities. Payments toward the interest portion of finance lease liabilities are classified as cash flows from operating activities. See Note 5, “ 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 to be 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 and are included in intangible assets, net in the unaudited condensed consolidated balance sheets. The Company capitalized approximately $0.2 million and $0.1 million of patent costs during the three months ended March 31, 2021 and 2020, respectively . Treasury Stock The Company accounts for the purchase of treasury stock under the cost method. Treasury stock that 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 In March 2020, the FASB issued Accounting Standards Update (“ ASU ”) 2020-04, “ Reference Rate Reform (Topic 848) ”, which provides temporary, optional expedients and exceptions to accounting guidance for certain contract modifications and hedging arrangements to ease financial reporting burdens as a result of market transitions from the London Interbank Offered Rate (“ LIBOR ”) to alternative reference rates. The guidance is available for prospective application upon its issuance and can generally be applied to contract modifications and hedging relationships entered into beginning March 12, 2020 through December 31, 2022. As of March 31, 2021, the Company has long-term debt outstanding which carries an interest rate tied to LIBOR, the agreement for which contemplates an interest rate alternative in the event that LIBOR is unavailable. The Company is evaluating the possibility of adoption and the related impact on its financial statements. If adopted, the Company does not expect the provisions of this ASU to have a material impact on its consolidated financial statements. In August 2020, the FASB issued ASU 2020-06, “ Accounting for Convertible Instruments and Contracts in an Entity’s Own Equity ,” which simplifies and clarifies certain calculation and presentation matters related to convertible equity and debt instruments. Specifically, ASU simplifies the accounting for such instruments by removing requirements to separately account for conversion features as a derivative under ASC Topic 815 and removing the requirement to account for beneficial conversion features on such instruments. Accounting Standards Update 2020-06 also provides clearer guidance surrounding disclosure of such instruments and provides specific guidance for how such instruments are to be incorporated in the calculation of Diluted EPS. The guidance under ASU 2020-06 is effective for fiscal years beginning after December 15, 2021, including interim periods within those fiscal years. Early adoption is permitted, but no earlier than fiscal years beginning after December 15, 2020. The Company adopted this standard on January 1, 2021 on a modified retrospective basis. There was no impact upon adoption. All other ASUs issued and not yet effective for the three months ended March 31, 2021, 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.

Inventory

Inventory	3 Months Ended
	Mar. 31, 2021
Inventory Disclosure [Abstract]
Inventory	Inventory Inventory consisted of the following (in thousands): March 31, 2021 December 31, 2020 Raw materials $ 477 $ 314 Work in process 6,226 4,316 Finished goods 4,879 5,731 Inventory $ 11,582 $ 10,361

Property and Equipment

Property and Equipment	3 Months Ended
	Mar. 31, 2021
Property, Plant and Equipment [Abstract]
Property and Equipment	Property and Equipment Property and equipment consisted of the following (in thousands): March 31, 2021 December 31, 2020 Leasehold improvements $ 6,010 $ 6,010 Laboratory and clean room equipment 14,828 15,524 Furniture and equipment 15,137 15,295 Construction in progress 4,295 3,321 Asset retirement cost 819 785 Property and equipment, gross 41,089 40,935 Less accumulated depreciation (30,045) (29,498) Property and equipment, net $ 11,044 $ 11,437 Depreciation expense for each of the three months ended March 31, 2021 and 2020 is summarized in the table below (amounts in thousands): Three Months Ended March 31, 2021 2020 Depreciation expense $ 1,161 $ 1,506 Depreciation expense is allocated amongst cost of sales, research and development, and selling, general, and administrative expense on the unaudited condensed consolidated statements of operations.

Leases

Leases	3 Months Ended
	Mar. 31, 2021
Leases [Abstract]
Leases	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. The Company subleases one of its leased industrial warehouse spaces. The sublease income from the facility offsets the lease expense associated with the facility. Sublease income for the facility is less than $0.1 million for the three months ended March 31, 2021 and is presented as a reduction to selling, general, and administrative expense on the unaudited condensed consolidated statements of operations in those periods. Information related to lease costs are as follows (amounts in thousands): . Three Months Ended March 31, 2021 2020 Operating lease cost $ 335 $ 350 Amortization of leased assets 237 239 Depreciation expense on finance lease 8 — Interest expense on finance lease 3 — Supplemental balance sheet information related to operating leases is as follows (amounts in thousands, except lease term and discount rate): March 31, 2021 December 31, 2020 Operating Leases Finance Leases Operating Leases Finance Leases Right of use asset $ 3,386 $ 181 $ 3,623 $ — Current right of use liability $ 1,210 $ 42 $ 1,176 $ — Noncurrent right of use liability 2,637 140 2,960 — Right of use liability $ 3,847 $ 182 $ 4,136 $ — Weighted-average remaining lease term (years) 4.2 years 3.8 years 4.4 years 0 years Weighted-average discount rate 10.0 % 8.3 % 10.0 % — % Maturities of operating leases liabilities are as follows (amounts in thousands): Year ending December 31, Operating Leases Finance Leases Total 2021 (excluding the three months ended March 31, 2021) $ 1,151 $ 41 1,192 2022 1,566 55 1,621 2023 507 55 562 2024 339 55 394 2025 339 5 344 2026 339 — 339 Thereafter 365 — 365 Total lease payments 4,606 211 4,817 Less: imputed interest (759) (29) (788) Right of use liability $ 3,847 $ 182 $ 4,029
Leases	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. The Company subleases one of its leased industrial warehouse spaces. The sublease income from the facility offsets the lease expense associated with the facility. Sublease income for the facility is less than $0.1 million for the three months ended March 31, 2021 and is presented as a reduction to selling, general, and administrative expense on the unaudited condensed consolidated statements of operations in those periods. Information related to lease costs are as follows (amounts in thousands): . Three Months Ended March 31, 2021 2020 Operating lease cost $ 335 $ 350 Amortization of leased assets 237 239 Depreciation expense on finance lease 8 — Interest expense on finance lease 3 — Supplemental balance sheet information related to operating leases is as follows (amounts in thousands, except lease term and discount rate): March 31, 2021 December 31, 2020 Operating Leases Finance Leases Operating Leases Finance Leases Right of use asset $ 3,386 $ 181 $ 3,623 $ — Current right of use liability $ 1,210 $ 42 $ 1,176 $ — Noncurrent right of use liability 2,637 140 2,960 — Right of use liability $ 3,847 $ 182 $ 4,136 $ — Weighted-average remaining lease term (years) 4.2 years 3.8 years 4.4 years 0 years Weighted-average discount rate 10.0 % 8.3 % 10.0 % — % Maturities of operating leases liabilities are as follows (amounts in thousands): Year ending December 31, Operating Leases Finance Leases Total 2021 (excluding the three months ended March 31, 2021) $ 1,151 $ 41 1,192 2022 1,566 55 1,621 2023 507 55 562 2024 339 55 394 2025 339 5 344 2026 339 — 339 Thereafter 365 — 365 Total lease payments 4,606 211 4,817 Less: imputed interest (759) (29) (788) Right of use liability $ 3,847 $ 182 $ 4,029

Intangible Assets

Intangible Assets	3 Months Ended
	Mar. 31, 2021
Goodwill and Intangible Assets Disclosure [Abstract]
Intangible Assets	Intangible Assets Intangible assets are summarized as follows (in thousands): March 31, 2021 December 31, 2020 Gross Carrying Amount Accumulated Amortization Net Carrying Amount Gross Carrying Amount Accumulated Amortization Net Carrying Amount Amortized intangible assets Patents and know how $ 9,516 $ (5,899) $ 3,617 $ 9,510 $ (5,730) $ 3,780 Licenses 1,414 (1,369) 45 1,414 (1,334) 80 Customer and supplier relationships 241 (176) 65 241 (172) 69 Non-compete agreements 120 (105) 15 120 (98) 22 Total amortized intangible assets $ 11,291 $ (7,549) $ 3,742 $ 11,285 $ (7,334) $ 3,951 Unamortized intangible assets Trade names and trademarks $ 1,008 $ 1,008 $ 1,008 $ 1,008 Patents in process 1,168 1,168 1,045 1,045 Total intangible assets $ 13,467 $ 5,918 $ 13,338 $ 6,004 Amortization expense for the three and three months ended March 31, 2021 and 2020 is summarized in the table below (amounts in thousands): Three Months Ended March 31, 2021 2020 Amortization expense $ 239 $ 271 Expected future amortization of intangible assets as of March 31, 2021, is as follows (in thousands): Year ending December 31, Estimated 2021 (excluding the three months ended March 31, 2021) $ 579 2022 692 2023 692 2024 692 2025 280 Thereafter 807 $ 3,742

Accrued Expenses

Accrued Expenses	3 Months Ended
	Mar. 31, 2021
Payables and Accruals [Abstract]
Accrued Expenses	Accrued Expenses Accrued expenses consisted of the following (in thousands): March 31, 2021 December 31, 2020 Legal costs $ 18,812 $ 14,822 Settlement costs 6,850 9,975 Estimated returns 498 688 Commissions to sales agents 2,153 2,141 Accrued clinical trials 610 651 Accrued rebates 377 886 Other 1,376 1,297 Total $ 30,676 $ 30,460

Long Term Debt

Long Term Debt	3 Months Ended
	Mar. 31, 2021
Debt Disclosure [Abstract]
Long Term Debt	Long Term Debt Hayfin Term Loan Agreement On June 30, 2020, the Company entered into a Loan Agreement with, among others, Hayfin Services, LLP, (“ Hayfin ”) an affiliate of Hayfin Capital Management LLP (the “ Hayfin Loan Agreement ”), which was funded (the “ Hayfin Loan Transaction ”) on July 2, 2020 (the “ Closing Date ”) and provided the Company with a senior secured term loan in an aggregate amount of $50 million (the “ Term Loan ”) and an additional delayed draw term loan (the “ DD TL ”, collectively, the “ Credit Facilities ”) in the form of a committed but undrawn facility. The Term Loan and the DD TL mature on June 30, 2025 (the “ Maturity Date ”). Interest is payable on the Term Loan and the DD TL for the balances outstanding quarterly through the Maturity Date. No principal payments on either the Term Loan or the DD TL are due and payable until the Maturity Date. The Term Loan and DD TL, which are senior secured obligations, were entered into together with the sale of the Company’s Series B Convertible Preferred Stock (as defined and described in Note 10, “ Equity ”) in an aggregate amount of up to $100 million (collectively, the “ Financing Transactions ”) in order to: (1) refinance the outstanding indebtedness (the “ Refinancing ”) under the Loan Agreement, dated as of June 10, 2019 (as amended and restated, the “ BT Term Loan Agreement ”), among the Company, the lenders and Blue Torch Finance LLC as administrative agent and collateral agent for such lenders, (2) pay fees and expenses incurred with certain financing transactions, and (3) finance the working capital, capital expenditures, and other general corporate purposes of the Company. The interest rate applicable to any borrowings under the Term Loan accrues at a rate equal to LIBOR (subject to a floor of 1.5%) plus a margin of 6.75% per annum (the “ Margin ”). If LIBOR is unavailable, the loan will carry interest at the Margin plus the greatest of the Prime Rate, the Federal Funds Rate plus 0.5% per annum, and 2.5%. The Margin is eligible for a reduction depending on the Total Net Leverage Ratio for the quarter; as follows: • 6.5% per annum if the Total Net Leverage Ratio (as defined in the Hayfin Loan Agreement) is less than 2.0x but greater than or equal to 1.0x, or • 6.0% per annum if the Total Net Leverage Ratio is less than 1.0x. An additional 3.0% margin is applied to the interest rate in the event of default as defined by the Hayfin Loan Agreement. At issuance and as of March 31, 2021, the Term Loan carried an interest rate of 8.3%. The Credit Facilities contain financial covenants requiring the Company, on a consolidated basis, to maintain the following: • Maximum Total Net Leverage Ratio of 4.5x through June 30, 2021, further reduced to 4.0x thereafter for the life of the loans, required to be calculated on a quarterly basis. • Minimum Liquidity (as defined in the Hayfin Loan Agreement) of $10 million, an at-all times, financial covenant tested monthly. The Credit Facilities also specify that any prepayment of the Term Loan, voluntary or mandatory, as defined in the Term Loan Agreement, will subject MiMedx to a prepayment premium applicable as of the date of the prepayment: • On or before the first anniversary of the Closing Date: ◦ A make-whole premium, equal to the greater of: ▪ 5% of the principal balance repaid, and ▪ 102% of the principal balance plus interest that would have been accrued from the repayment date to 12 months following the Closing Date. • After the first anniversary of the Closing Date but on or before the second anniversary of the Closing Date: 2% of the principal balance repaid. • After the second anniversary of the Closing Date: 1% of the principal balance repaid. • After the third anniversary of the Closing Date: 0% of the principal balance repaid. The Loan Agreement also includes 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 Credit Facilities may be accelerated or the lenders’ commitments terminated. The mandatory prepayments are also required in the event of a change in control, incurring other indebtedness, certain proceeds from disposal of assets and insured casualty event. Annually, beginning with the fiscal year ending December 31, 2021, the Company is required to prepay the outstanding loans based on the percentage of the Excess Cash Flow (as defined in the Hayfin Loan Agreement), if such is generated, with the percentage determined based on the Total Net Leverage thresholds. Hayfin maintains a first-priority security interest in substantially all of the Company’s assets. Original issue discount and deferred financing costs incurred as part of the Financing Transactions were allocated between the sale of the Series B Convertible Preferred Stock and the Hayfin Term Loan on the basis of the relative fair values of the transactions. The costs allocated to the Hayfin Term Loan were further allocated between the Term Loan and the DD TL on the basis of the maximum potential principal outstanding between the Credit Facilities. A summary of the allocation of the deferred financing costs and original issue discount between the Term Loan and the DD TL on July 2, 2020 was as follows (amounts in thousands): July 2, 2020 Term Loan DD TL Total Long term debt Other current assets Original issue discount $ 333 $ 167 $ 500 Deferred financing costs 2,169 1,084 3,253 Deferred financing costs and original issue discount associated with the Term Loan are amortized using the effective interest method through the Maturity Date. The amortization of such amounts are presented as part of interest expense, net on the unaudited condensed consolidated statement of operations for the three months ended March 31, 2021. Unamortized deferred financing costs and original issue discount associated with the Term Loan are presented as a reduction to the principal balance on the Term Loan as part of long term debt, net on the unaudited condensed consolidated balance sheet as of March 31, 2021. Deferred financing costs and original issue discount associated with the DD TL are amortized using the straight line method through the earlier of the expiration of the DD TL commitment term on June 30, 2021, or the date the balance of the DD TL is funded. To the extent that there are unamortized deferred financing costs or original issue discount associated with the DD TL will be amortized using the effective interest method through the Maturity Date. Amortization of these amounts are presented as part of interest expense, net on the unaudited condensed consolidated statement of operations for the three months ended March 31, 2021. Unamortized deferred financing costs and original issue discount associated with the DD TL are presented as other current assets on the unaudited condensed consolidated balance sheet as of March 31, 2021. In addition, the DD TL is subject to an additional commitment fee of 1% per annum of the amount undrawn, which is recognized as interest expense. The DD TL was not drawn upon as of March 31, 2021. The balances of the Term Loan as of March 31, 2021 and December 31, 2020 were as follows (amounts in thousands): March 31, 2021 December 31, 2020 Outstanding principal $ 50,000 $ 50,000 Deferred financing costs (1,908) (1,996) Original issue discount (293) (307) Long term debt $ 47,799 $ 47,697 Interest expense related to the Term Loan, included in interest expense, net in the unaudited condensed consolidated statements of operations, was as follows (amounts in thousands): Three Months Ended March 31, 2021 Stated interest $ 1,031 Amortization of deferred financing costs 89 Accretion of original issue discount 13 Interest expense $ 1,133 Interest expense related to the DD TL, included in interest expense, net in the unaudited condensed consolidated statements of operations, was as follows (amounts in thousands): Three Months Ended March 31, 2021 Commitment fee $ 63 Amortization of deferred financing costs 271 Accretion of original issue discount 41 Interest expense $ 375 Principal payments on the Term Loan as of March 31, 2021 are as follows: Year ending December 31, Principal 2021 (excluding the three months ended March 31, 2021) $ — 2022 — 2023 — 2024 — 2025 50,000 Thereafter — Total long term debt $ 50,000 As the Company has not borrowed on the DD TL as of March 31, 2021, there are no principal payments owed on the DD TL. As of March 31, 2021, the fair value of the Term Loan was $51.4 million. This valuation was calculated based on a series of Level 2 and Level 3 inputs, including a discount rate based on the credit risk spread of debt instruments of similar risk character in reference to U.S. Treasury instruments with similar maturities, with an incremental risk premium for risk factors specific to the Company. To derive the fair value of the Term Loan, the remaining cash flows associated with the Term Loan were discounted to March 31, 2021 using this discount rate. Blue Torch Term Loan On June 10, 2019, the Company entered into the BT Term Loan Agreement with the subsidiaries of the Company as guarantors and 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, pursuant to which the full amount of $75 million 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. On April 22, 2020, the Company amended its BT Loan Agreement with Blue Torch. The amendment provided for an increase in the maximum Total Leverage Ratio, which was a quarterly test, for the remainder of 2020, and also provided for a reduction in the minimum Liquidity requirement from April 2020 through and including November 2020. In connection with the amendment, the Company agreed to pay a one-time fee of $0.7 million, added to the principal balance, and a 1 percentage point increase in the interest rate to LIBOR plus 9%. On July 2, 2020, a portion of the proceeds from each of the sales of the Company’s Series B Convertible Preferred Stock and the borrowings from 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. The Company has no continuing obligations related to the BT Term Loan. Interest expense related to the BT Term Loan, included in interest expense, net in the unaudited condensed consolidated statements of operations was as follows (amounts in thousands): Three Months Ended March 31, 2020 Interest on principal balance $ 1,840 Accretion of original issue discount 167 Amortization of deferred financing costs 491 Total BT Term Loan interest expense $ 2,498

Net Loss Per Common Share

Net Loss Per Common Share	3 Months Ended
	Mar. 31, 2021
Earnings Per Share [Abstract]
Net Loss Per Common Share	Net Loss Per Common ShareNet loss per common share is calculated using two methods: basic and diluted. Basic Net Loss Per Common Share Basic net loss per common share is calculated as net loss available to common stockholders divided by weighted average common shares outstanding. Net loss available to common stockholders is calculated as net loss less (i) dividends accumulated on the Company’s Series B Convertible Preferred Stock during the period, and (ii) periodic accretion of the increasing-rate dividend feature. The following table provides a reconciliation of net loss to net loss available to common stockholders and calculation of basic net loss per common share for each of the three months ended March 31, 2021 and 2020 (amounts in thousands, except share and per share amounts): Three Months Ended March 31, 2021 2020 Net loss $ (8,382) $ (4,821) Adjustments to reconcile to net (loss) income available to common stockholders Accumulated dividend on Series B Convertible Preferred Stock 1,006 — Accretion of increasing-rate dividend feature 462 — Total adjustments 1,468 — Net loss available to common stockholders $ (9,850) $ (4,821) Weighted average common shares outstanding 109,401,383 107,538,509 Basic net loss per common share $ (0.09) $ (0.04) Diluted Net Loss Per Common Share Diluted net loss per common share is calculated as net loss available to common stockholders, adjusted for dividends on convertible preferred stock (to the extent such conversions would be dilutive), divided by weighted average common shares outstanding plus potential common shares. The calculation of potential common shares considers incremental shares resulting from certain transactions, including the exercise of stock options and the issuance of restricted stock using the treasury stock method, as well as the hypothetical conversion of the Company’s Series B Convertible Preferred Stock using the if-converted method. The treasury stock method assumes that proceeds from the transaction are used to purchase common stock at the average market price throughout the period. The if-converted method adds back dividends accrued or deemed on the Company’s Series B Convertible Preferred Stock and assumes conversion as of the later of the beginning of the period or the original transaction date. Each individual transaction is assessed for its dilutive effect on net loss per common share. To the extent that the transaction is antidilutive, or does not reduce net loss per common share, the effect is excluded from the calculation. The following table sets forth the computation of diluted net loss per common share (in thousands, except share and per share amounts): Three Months Ended March 31, 2021 2020 Net loss available to common stockholders $ (9,850) $ (4,821) Dividends on Series B Convertible Preferred Stock 1,468 — Numerator $ (9,850) $ (4,821) Weighted average shares outstanding 109,401,383 107,538,509 Potential common shares (a) 30,470,089 2,706,804 Weighted average shares outstanding adjusted for potential common shares 109,401,383 107,538,509 Diluted net loss per common share $ (0.09) $ (0.04) (a) Potential common shares reflects hypothetical transactions involving convertible securities and share-based payment awards using the if-converted and treasury stock methods, respectively. The effect of each of these adjustments on the calculation is presented in the table below: Three Months Ended March 31, 2021 2020 Series B Convertible Preferred Stock 26,497,570 — Restricted stock awards 1,629,273 1,769,847 Restricted Stock Unit Awards 1,349,898 — Outstanding Stock Options 964,640 919,555 Performance Based Awards 28,708 17,402 Potential common shares 30,470,089 2,706,804

Equity

Equity	3 Months Ended
	Mar. 31, 2021
Equity [Abstract]
Equity	Equity 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 (individually, the “ Holder ”, collectively the “ Holders ”) 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, dated as of June 30, 2020 (the “ Securities Purchase Agreement ”), for an aggregate purchase price of $100 million (the “ Preferred Stock Transaction ”). The Series B Preferred Stock pays a 4.0% cumulative dividend per annum prior to the quarterly dividend payment ending on June 30, 2021, and a 6.0% cumulative dividend per annum thereafter. Dividends are declared at the sole discretion of the Company’s board of directors. Dividends are paid at the end of each quarter based for dividend amounts that accumulate beginning on the last payment date through the day prior to the end of each quarter. In lieu of paying a dividend, the Company may elect to accrue the dividend owed to shareholders. Accrued dividend balances accumulate dividends at the prevailing dividend rate for each dividend period for which they are outstanding. Each share of Series B Preferred Stock, including any accumulated and unpaid dividends, is convertible into Company’s common stock at any time at the option of the Holder at a conversion price of $3.85 per common share, or 259.74 common shares for each share of Series B Preferred Stock prior to any accumulated and unpaid dividends. The Series B Preferred Stock, including any accumulated and unpaid dividends, automatically converts into common stock at any time after the third anniversary of the issuance date, provided that the common stock has traded at 200% or more of the conversion price for 20 out of 30 consecutive trading days and on such date of conversion the common stock has traded at 200% or more of the conversion price. Holders of the Series B Preferred Stock, voting as a class, are entitled to elect two members to the board of directors. Holders of the Series B Preferred Stock are entitled to vote on all matters to be voted on by the Company’s shareholders on an as-converted basis as a single class with the common stock not to exceed 19.9% of the total voting stock of the Company. Holders of the Series B Preferred Stock are also entitled to a liquidation preference in an amount equal to the original issue price plus all accumulated and unpaid dividends in the event of a liquidation, dissolution, or winding-up of the Company. The Series B Preferred Stock instrument contains an increasing-rate cumulative dividend feature. The Company determined the present value of the difference between the (1) dividends that will be payable, in the period preceding commencement of the perpetual dividend; and (2) the perpetual dividend amount for a corresponding number of periods to ascribe a fair value to this feature. The present value is calculated using a market rate for dividend yield. The Company calculated the amount of the increasing-rate dividend feature as $1.8 million. This amount is amortized as a deemed dividend to preferred shareholders using the effective interest method through the commencement date of the Perpetual Dividend Rate. During the three months ended March 31, 2021, the Company recognized $0.5 million of deemed dividends related to the amortization of the increasing rate dividend feature. If the Company undergoes a change of control, the Company will have the option to repurchase some or all of the then-outstanding shares of Series B Preferred Stock for cash in an amount equal to the liquidation preference, subject to the rights of the holders of the Series B Preferred Stock in connection with such change in control. If the Company does not exercise such repurchase right, holders of the Series B Preferred Stock will have the option to (1) require the Company to repurchase any or all of their then-outstanding shares of Series B Preferred Stock for cash in an amount equal to the liquidation preference or (2) convert the Series B Preferred Stock, including accumulated and unpaid dividends into common stock and receive their pro rata consideration thereunder. Because the contingent redemption of the Series B Preferred Stock by the holders in the event of change in control is outside the Company’s control, the Series B Preferred Stock is classified as temporary equity. The below table illustrates changes in the Company’s balance of Series B Preferred Stock for the three months ended March 31, 2021 (in thousands, except share amounts): Series B Preferred Stock Shares Amount Balance at December 31, 2020 100,000 $ 91,568 Deemed dividends — 462 Balance at March 31, 2021 100,000 $ 92,030 The Company has not declared or paid any dividends on the Series B Convertible Preferred Stock since issuance. Dividends in arrears as of March 31, 2021 was $3.0 million. As this amount has not been declared, the Company has not recorded this amount on its unaudited condensed consolidated balance sheet as of March 31, 2021. Based on accumulated dividends as of March 31, 2021, the Series B Convertible Preferred Stock was convertible into an aggregate of 26,758,916 shares of the Company’s common stock.

Income taxes

Income taxes	3 Months Ended
	Mar. 31, 2021
Income Tax Disclosure [Abstract]
Income taxes	Income Taxes The effective tax rates for the Company were (0.7)% and 70.1% for the three months ended March 31, 2021 and March 31, 2020, respectively. These effective tax rates include the impact of discrete items of $0 and $11.4 million for the three months ended March 31, 2021 and March 31, 2020, respectively. As of March 31, 2021, the projected annual effective tax rate for 2021 is (0.7)%. The discrete items recorded for the three months ended March 31, 2021 were $0. The discrete items recorded for the three months ended March 31, 2020 were 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 $11.3 million and an income tax benefit of the same amount. No benefit had been recognized with respect to the net operating losses due to a previously-recorded valuation allowance.

Supplemental Disclosure of Cash

Supplemental Disclosure of Cash Flow and Non-Cash Investing and Financing Activities	3 Months Ended
	Mar. 31, 2021
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 non-cash activities are as follows (in thousands): Three Months Ended March 31, 2021 2020 Cash paid for interest $ 1,094 $ 1,840 Income taxes paid 4 6 Non-cash activities: Lease right of use asset and liability 189 — Note receivable for sale of property and equipment 75 — Purchases of equipment in accounts payable 159 — Fair value of non-cash consideration received for option exercise 380 — Deemed dividends on Series B Convertible Preferred Stock 462 —

Contractual Commitments and Con

Contractual Commitments and Contingencies	3 Months Ended
	Mar. 31, 2021
Commitments and Contingencies Disclosure [Abstract]
Contractual Commitments and Contingencies	Contractual Commitments and Contingencies Contractual Commitments In addition to the leases noted under Note 5, “Leases,” the Company has commitments for meeting space. These commitments expire over the 3 years following March 31, 2021, and generally contain renewal options. 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 unaudited condensed consolidated financial statements as of March 31, 2021 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, as well as the cost to resolve claims that are either not probable or not estimable at this time, 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 14, “ Commitments and Contingencies ” in the 2020 Form 10-K. As of March 31, 2021, the Company has accrued $6.9 million related to the legal proceedings discussed below. Of this amount, $0.7 million is indemnified by insurance. This indemnification receivable is recorded as part of other current assets in the unaudited condensed consolidated balance sheet as of March 31, 2021. The Company paid $4.4 million toward the resolution of legal matters involving the Company during the three months ended March 31, 2021. The following is a description of certain litigation and regulatory matters: 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 (“ CPFI ”) as lead plaintiff. On May 1, 2019, CPFI 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, CPFI was granted leave to file an amended complaint. CPFI 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. On March 25, 2021, the Court granted defendants’ respective motions to dismiss, finding that CPFI lacked standing to bring the underlying claims and also could not establish loss causation because it sold all of its shares in MiMedx prior to any corrective disclosures, and dismissed the case. On April 22, 2021, CPFI filed a motion for reconsideration of the dismissal and for leave to amend to add a new plaintiff to attempt to cure the standing and loss causation issues. Investigations 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. On February 8, 2021, the Company received a subpoena issued by the Department of Defense Office of Inspector General seeking records regarding the sales of the Company’s micronized and other products to federal medical facilities and federal contracting offices, including those operated by the Department of Veterans Affairs or the Department of Defense. The subpoena also seeks information regarding the Company’s communications with the FDA regarding its products. The Company understands that the Office of the United States Attorney for the Western District of Washington Civil Division is overseeing the investigation, which is being conducted principally by agents employed by the Department of the Army Criminal Investigation Command. The Company is cooperating with the government’s investigation and at this time the Company is unable to predict the outcome of the investigation, including whether the investigation will result in any action or proceeding against us. 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 cooperated with the investigation and has settled this matter. 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 parties reached an agreement to settle this matter and a stipulation of dismissal was filed on February 26, 2021. 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 parties have reached an agreement to resolve this matter and a stipulation of dismissal with prejudice was filed on March 22, 2021. On January 12, 2021, the Company filed suit in the Circuit Court of the Eleventh Judicial District in and for Miami-Dade County, Florida ( MiMedx Group, Inc. v. Petit, et. al. ) against its former CEO, Parker “Pete” Petit, and its former COO, Bill Taylor, seeking a determination of its rights and obligations under indemnification agreements with Petit and Taylor following a federal jury’s guilty verdict against Petit for securities fraud and Taylor for conspiracy to commit securities fraud. The Company is seeking a declaratory judgment that it is not obligated to indemnify or advance expenses to Petit and Taylor in connection with certain cases to which Petit and Taylor are parties and also seeking to recoup amounts previously paid on behalf of Petit and Taylor in connection with such cases. On April 15, 2021, Quinn Emanuel Urquhart & Sullivan, LLP, Freshfields Bruckhaus Deringer US LLP, and Kobre Kim, LLP, law firms who have represented Mr. Petit and Mr. Taylor in various legal actions, including their criminal trial, filed suit in the Supreme Court of the State of New York County of New York against the Company ( Quinn Emanuel Urquhart & Sullivan, LLP, et al. v. MiMedx Group, Inc. ) for breach of contract, breach of implied-in-fact contract, quasi-contract/unjust enrichment, promissory estoppel, equitable estoppel, and account stated seeking to enforce the Company’s alleged obligation to pay the firms for the legal fees and expenses incurred during their representations of Mr. Petit and Mr. Taylor. The Company intends to defend itself against these allegations. 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 parties have reached an agreement to settle this dispute. 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 may 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.

Revenue Data by Customer Type

Revenue Data by Customer Type	3 Months Ended
	Mar. 31, 2021
Segment Reporting [Abstract]
Revenue Data by Customer Type	Revenue Data by Customer Type MiMedx has two primary distribution channels: (1) direct to customers (healthcare professionals and/or facilities) (“ Direct Customers ”), and (2) sales through distributors (“ Distributors ”). 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, 2021 or 2020. Below is a summary of net sales by each customer type (in thousands): Three Months Ended March 31, 2021 2020 Direct Customers $ 57,555 59,896 Distributors 2,412 1,840 Total $ 59,967 $ 61,736

Share-based Compensation

Share-based Compensation	3 Months Ended
	Mar. 31, 2021
Share-based Payment Arrangement [Abstract]
Stock-based Compensation	Share-based Compensation Restricted Stock Awards The Company has issued several classes of restricted stock awards to employees: restricted stock (“ RSAs ”), restricted stock unit awards (“ RSUs ”), and performance stock unit awards (“ PSUs ”). The following is summary information for restricted stock awards for the three months ended March 31, 2021. As of March 31, 2021, there was $36.3 million of unrecognized share-based compensation expense related to restricted stock awards. That expense is expected to recognized over a weighted-average period of 2.67 years, which approximates the remaining vesting period of these grants. The below table summarizes activity of unvested restricted stock awards by award type from January 1, 2021 through March 31, 2021. Unvested RSA awards noted below are included in issued and outstanding common stock as of March 31, 2021, while unvested RSUs and PSUs are not included in issued or outstanding common stock as of March 31, 2021. RSA RSU PSU Number of Weighted-Average Grant Date Number of Weighted-Average Grant Date Number of Weighted-Average Grant Date Unvested at January 1, 2021 2,175,859 $ 4.78 2,325,273 $ 5.90 35,212 $ 7.10 Granted — — 2,818,085 10.07 — — Vested (222,741) 8.60 (742,001) 5.90 — — Forfeited (35,589) 3.76 (32,856) 5.90 — — Unvested at March 31, 2021 1,917,529 $ 4.36 4,368,501 $ 8.59 35,212 $ 7.10 Stock Options A summary of stock option activity for the three months ended March 31, 2021 is presented below: Number of Weighted- Weighted- Aggregate Outstanding at January 1, 2021 2,025,683 $ 4.62 Granted — — Exercised (352,623) 3.67 Unvested options forfeited (50,000) 1.23 Vested options expired — — Outstanding at March 31, 2021 1,623,060 4.93 2.16 8,714,632 Exercisable at March 31, 2021 1,623,060 $ 4.93 2.16 $ 8,714,632

Subsequent Events

Subsequent Events	3 Months Ended
	Mar. 31, 2021
Subsequent Events [Abstract]
Subsequent Events	Subsequent Events

Significant Accounting Polici_2

Significant Accounting Policies (Policies)	3 Months Ended
	Mar. 31, 2021
Accounting Policies [Abstract]
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. 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. The operating results for the three months ended March 31, 2021 and 2020 are not necessarily indicative of the results that may be expected for the fiscal year. The balance sheet as of December 31, 2020 was 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. These financial statements reflect all adjustments which are, in the opinion of management, necessary to a fair statement of the results for the interim periods presented. These unaudited condensed consolidated financial statements should be read in conjunction with the historical consolidated financial statements of the Company included in the 2020 Form 10-K.
Use of Estimates	Use of Estimates The unaudited condensed 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 unaudited condensed consolidated financial statements and the reported unaudited condensed 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 regarding asset retirement obligations, estimates for contingent liabilities, the measurement of right-of-use assets and lease 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. In addition to the above, the Company has considered the potential effects of the Covid-19 Pandemic with respect to its determinations surrounding impairments, increases in allowances for credit losses, other expenses, and changes in accounting judgments that have or are reasonably likely to have a material impact on the unaudited condensed consolidated financial statements.
Principles of Consolidation	Principles of Consolidation The unaudited condensed 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 held at various banks. The Company considers all highly-liquid investments purchased with an original maturity of three months or less at the date of purchase and money market mutual funds to be cash equivalents.
Accounts 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. Bad debt expense and the allowance for doubtful accounts are based on historical trends and current expectations for credit losses and reasonable and supportable forecasts. The Company’s policy to reserve for potential bad debts is based on the aging of the individual receivables as well as customer-specific qualitative factors, such as bankruptcy proceedings. The Company manages credit risk by routinely performing credit checks on customers prior to sales. The individual receivables are written-off after all reasonable efforts to collect the funds have been made. Actual write-offs may differ from the amounts reserved.
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. Slow moving and obsolete inventory that is no longer needed due to diminished market demand is presented at the lower of cost or net realizable value.
Goodwill	Goodwill Goodwill represents the excess of purchase price over the fair value of net assets of acquired businesses. The Company assesses the recoverability of its goodwill at least annually on October 1 and whenever events or substantive changes in circumstances indicate that the asset may be impaired. The Company may first choose to assess qualitative factors to determine whether it is more likely than not that the fair value of a reporting unit is less than its carrying amount. If the Company determines that it is more likely than not that the fair value of a reporting unit is less than its carrying amount, then the Company performs a quantitative analysis. The Company may also choose to bypass the qualitative assessment and proceed directly to the quantitative analysis. As of March 31, 2021, the Company concluded it operates as one reporting unit. Under the quantitative test, if the carrying value of the reporting unit exceeds its fair value, goodwill impairment is recognized for the amount that the carrying value exceeds fair value, not to exceed the total amount of goodwill allocated to the reporting unit. The Company determines fair value using income and market approaches. Under the income approach, the fair value of the Company is the present value of its future economic benefits. These benefits can include revenue, cost savings, tax deductions, and proceeds from its disposition. Value indications are developed by discounting expected cash flows to their present value at a rate of return that incorporates the risk-free rate for the use of funds, industry trends, and entity-specific risks as of the goodwill impairment testing date. Under the market approach, the Company uses observed fair values of a set of companies with comparable business models to the reporting unit under evaluation for purposes of determining the fair value of the reporting unit. These amounts are reconciled to the Company’s market capitalization as of the test date for reasonableness. Change in Annual Goodwill Impairment Testing Date The Company elected to change its annual goodwill and indefinite-lived intangible asset impairment testing date from September 30 to October 1. The change in the annual impairment testing date provides the Company with more time in identifying and calculating any impairments and to maximize the use of the Company’s available resources.
Revenue Recognition	Revenue Recognition The Company sells its products primarily to individual customers and independent distributors (collectively referred to as “ customers ”). Customers obtain and use products either through ship and bill arrangements or consignment arrangements. Under ship and bill arrangements, the customer submits an order. Upon approval of the sales order, the Company ships product to the customer and invoices them for the product sold. Under consignment arrangements, the customer takes possession of the product, but the Company retains title until the implantation, or application of the Company’s product to the end user. The Company recognizes revenue as performance obligations are fulfilled; which occurs upon the shipment of product to the customers for ship and bill orders or upon implantation for consignment sales. Revenue is recognized based on consideration the Company expects to be entitled to from the sale. This consists of the gross selling price of the product, less any discounts or rebates (collectively, “ deductions ” or “ sales deductions ”). Gross selling price is a standard set by the Company for all customers unless a contract governing the sale provides for a specified price. Sales deductions are specified in individual contracts with customers and are generally achieved based on total sales during a specified period. The Company estimates the total sales deductions that a specific customer will achieve over the relevant term and applies the reduction to sales as they are made throughout the period. Rebates owed to customers are accrued and recorded in accrued expenses on the unaudited condensed consolidated balance sheets. The Company acts as principal in all of its customer arrangements and 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 and the Company has elected to treat shipping costs as activities to fulfill the promise to transfer the product. 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 on 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. In addition to the above revenue recognition policy, the Company recognizes revenue from customers with balances outstanding as of September 30, 2019 for which all of the criteria necessary for revenue recognition were not met at the time of shipment and that such criteria would not be met until collection of such sales (the “ Remaining Contracts ”). This was in accordance with the change in the Company’s revenue recognition pattern beginning September 30, 2019 (the “ Transition ”). A summary of the effects of cash collections on the Remaining Contracts on the unaudited condensed consolidated statements of operations for each of the three months ended March 31, 2021 and 2020 are as follows (amounts in thousands): Three months ended March 31, 2021 2020 Net sales $ 298 $ 4,495 Cost of sales 42 629 Gross profit $ 256 $ 3,866 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 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, which were included in Right of use asset, Other current liabilities and Other liabilities, respectively. As of March 31, 2021, the Company has both finance and operating leases. 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. 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 determination of whether the Company is reasonably certain to exercise a renewal or termination option is reassessed as new information arises and is accounted for prospectively as of the point in time the determination is made regarding the modification of the lease term. The Company uses its 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. For operating leases, lease expense is recognized on a straight-line basis over the lease term through selling, general and administrative expense on the unaudited condensed consolidated statements of operations. For finance leases, the right of use asset is amortized, straight-line, over the life of the lease as depreciation expense, which is included as a component of through selling, general and administrative expense on the unaudited condensed consolidated statements of operations. The Company recognizes interest expense on finance lease liabilities based on the incremental borrowing rate at lease inception applied to the outstanding right of use liability. The Company does not recognize interest expense on operating lease liabilities.
Patent Costs	Patent CostsThe Company incurs certain legal and related costs in connection with patent applications for tissue-based products and processes. The Company capitalizes such costs to be 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 and are included in intangible assets, net in the unaudited condensed consolidated balance sheets.
Treasury Stock	Treasury Stock The Company accounts for the purchase of treasury stock under the cost method. Treasury stock that 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 and Adopted Accounting Standards In March 2020, the FASB issued Accounting Standards Update (“ ASU ”) 2020-04, “ Reference Rate Reform (Topic 848) ”, which provides temporary, optional expedients and exceptions to accounting guidance for certain contract modifications and hedging arrangements to ease financial reporting burdens as a result of market transitions from the London Interbank Offered Rate (“ LIBOR ”) to alternative reference rates. The guidance is available for prospective application upon its issuance and can generally be applied to contract modifications and hedging relationships entered into beginning March 12, 2020 through December 31, 2022. As of March 31, 2021, the Company has long-term debt outstanding which carries an interest rate tied to LIBOR, the agreement for which contemplates an interest rate alternative in the event that LIBOR is unavailable. The Company is evaluating the possibility of adoption and the related impact on its financial statements. If adopted, the Company does not expect the provisions of this ASU to have a material impact on its consolidated financial statements. In August 2020, the FASB issued ASU 2020-06, “ Accounting for Convertible Instruments and Contracts in an Entity’s Own Equity ,” which simplifies and clarifies certain calculation and presentation matters related to convertible equity and debt instruments. Specifically, ASU simplifies the accounting for such instruments by removing requirements to separately account for conversion features as a derivative under ASC Topic 815 and removing the requirement to account for beneficial conversion features on such instruments. Accounting Standards Update 2020-06 also provides clearer guidance surrounding disclosure of such instruments and provides specific guidance for how such instruments are to be incorporated in the calculation of Diluted EPS. The guidance under ASU 2020-06 is effective for fiscal years beginning after December 15, 2021, including interim periods within those fiscal years. Early adoption is permitted, but no earlier than fiscal years beginning after December 15, 2020. The Company adopted this standard on January 1, 2021 on a modified retrospective basis. There was no impact upon adoption. All other ASUs issued and not yet effective for the three months ended March 31, 2021, 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 Significant Accounting Policies (Tables)	3 Months Ended
	Mar. 31, 2021
Accounting Policies [Abstract]
Assessment of Revenue under ASC 606	A summary of the effects of cash collections on the Remaining Contracts on the unaudited condensed consolidated statements of operations for each of the three months ended March 31, 2021 and 2020 are as follows (amounts in thousands): Three months ended March 31, 2021 2020 Net sales $ 298 $ 4,495 Cost of sales 42 629 Gross profit $ 256 $ 3,866

Inventory (Tables)

Inventory (Tables)	3 Months Ended
	Mar. 31, 2021
Inventory Disclosure [Abstract]
Inventory	Inventory consisted of the following (in thousands): March 31, 2021 December 31, 2020 Raw materials $ 477 $ 314 Work in process 6,226 4,316 Finished goods 4,879 5,731 Inventory $ 11,582 $ 10,361

Property and Equipment (Tables)

Property and Equipment (Tables)	3 Months Ended
	Mar. 31, 2021
Property, Plant and Equipment [Abstract]
Summary of Property and Equipment	Property and equipment consisted of the following (in thousands): March 31, 2021 December 31, 2020 Leasehold improvements $ 6,010 $ 6,010 Laboratory and clean room equipment 14,828 15,524 Furniture and equipment 15,137 15,295 Construction in progress 4,295 3,321 Asset retirement cost 819 785 Property and equipment, gross 41,089 40,935 Less accumulated depreciation (30,045) (29,498) Property and equipment, net $ 11,044 $ 11,437
Schedule of Depreciation Expense	Depreciation expense for each of the three months ended March 31, 2021 and 2020 is summarized in the table below (amounts in thousands): Three Months Ended March 31, 2021 2020 Depreciation expense $ 1,161 $ 1,506

Leases (Tables)

Leases (Tables)	3 Months Ended
	Mar. 31, 2021
Leases [Abstract]
Lease Costs	Information related to lease costs are as follows (amounts in thousands): . Three Months Ended March 31, 2021 2020 Operating lease cost $ 335 $ 350 Amortization of leased assets 237 239 Depreciation expense on finance lease 8 — Interest expense on finance lease 3 —
Assets and Liabilities	Supplemental balance sheet information related to operating leases is as follows (amounts in thousands, except lease term and discount rate): March 31, 2021 December 31, 2020 Operating Leases Finance Leases Operating Leases Finance Leases Right of use asset $ 3,386 $ 181 $ 3,623 $ — Current right of use liability $ 1,210 $ 42 $ 1,176 $ — Noncurrent right of use liability 2,637 140 2,960 — Right of use liability $ 3,847 $ 182 $ 4,136 $ — Weighted-average remaining lease term (years) 4.2 years 3.8 years 4.4 years 0 years Weighted-average discount rate 10.0 % 8.3 % 10.0 % — %
Maturities of Operating Lease Liabilities	Maturities of operating leases liabilities are as follows (amounts in thousands): Year ending December 31, Operating Leases Finance Leases Total 2021 (excluding the three months ended March 31, 2021) $ 1,151 $ 41 1,192 2022 1,566 55 1,621 2023 507 55 562 2024 339 55 394 2025 339 5 344 2026 339 — 339 Thereafter 365 — 365 Total lease payments 4,606 211 4,817 Less: imputed interest (759) (29) (788) Right of use liability $ 3,847 $ 182 $ 4,029
Maturities of Financing Lease Liabilities	Maturities of operating leases liabilities are as follows (amounts in thousands): Year ending December 31, Operating Leases Finance Leases Total 2021 (excluding the three months ended March 31, 2021) $ 1,151 $ 41 1,192 2022 1,566 55 1,621 2023 507 55 562 2024 339 55 394 2025 339 5 344 2026 339 — 339 Thereafter 365 — 365 Total lease payments 4,606 211 4,817 Less: imputed interest (759) (29) (788) Right of use liability $ 3,847 $ 182 $ 4,029

Intangible Assets (Tables)

Intangible Assets (Tables)	3 Months Ended
	Mar. 31, 2021
Goodwill and Intangible Assets Disclosure [Abstract]
Intangible Assets Activity Summary - Indefinite-lived	Intangible assets are summarized as follows (in thousands): March 31, 2021 December 31, 2020 Gross Carrying Amount Accumulated Amortization Net Carrying Amount Gross Carrying Amount Accumulated Amortization Net Carrying Amount Amortized intangible assets Patents and know how $ 9,516 $ (5,899) $ 3,617 $ 9,510 $ (5,730) $ 3,780 Licenses 1,414 (1,369) 45 1,414 (1,334) 80 Customer and supplier relationships 241 (176) 65 241 (172) 69 Non-compete agreements 120 (105) 15 120 (98) 22 Total amortized intangible assets $ 11,291 $ (7,549) $ 3,742 $ 11,285 $ (7,334) $ 3,951 Unamortized intangible assets Trade names and trademarks $ 1,008 $ 1,008 $ 1,008 $ 1,008 Patents in process 1,168 1,168 1,045 1,045 Total intangible assets $ 13,467 $ 5,918 $ 13,338 $ 6,004
Intangible Assets Activity Summary - Finite-lived	Intangible assets are summarized as follows (in thousands): March 31, 2021 December 31, 2020 Gross Carrying Amount Accumulated Amortization Net Carrying Amount Gross Carrying Amount Accumulated Amortization Net Carrying Amount Amortized intangible assets Patents and know how $ 9,516 $ (5,899) $ 3,617 $ 9,510 $ (5,730) $ 3,780 Licenses 1,414 (1,369) 45 1,414 (1,334) 80 Customer and supplier relationships 241 (176) 65 241 (172) 69 Non-compete agreements 120 (105) 15 120 (98) 22 Total amortized intangible assets $ 11,291 $ (7,549) $ 3,742 $ 11,285 $ (7,334) $ 3,951 Unamortized intangible assets Trade names and trademarks $ 1,008 $ 1,008 $ 1,008 $ 1,008 Patents in process 1,168 1,168 1,045 1,045 Total intangible assets $ 13,467 $ 5,918 $ 13,338 $ 6,004 Amortization expense for the three and three months ended March 31, 2021 and 2020 is summarized in the table below (amounts in thousands): Three Months Ended March 31, 2021 2020 Amortization expense $ 239 $ 271
Estimated Future Amortization Expense for Intangible Assets	Expected future amortization of intangible assets as of March 31, 2021, is as follows (in thousands): Year ending December 31, Estimated 2021 (excluding the three months ended March 31, 2021) $ 579 2022 692 2023 692 2024 692 2025 280 Thereafter 807 $ 3,742

Accrued Expenses (Tables)

Accrued Expenses (Tables)	3 Months Ended
	Mar. 31, 2021
Payables and Accruals [Abstract]
Schedule of Accrued Liabilities	Accrued expenses consisted of the following (in thousands): March 31, 2021 December 31, 2020 Legal costs $ 18,812 $ 14,822 Settlement costs 6,850 9,975 Estimated returns 498 688 Commissions to sales agents 2,153 2,141 Accrued clinical trials 610 651 Accrued rebates 377 886 Other 1,376 1,297 Total $ 30,676 $ 30,460

Long Term Debt (Tables)

Long Term Debt (Tables)	3 Months Ended
	Mar. 31, 2021
Debt Disclosure [Abstract]
Schedule of Debt Issuance Costs	A summary of the allocation of the deferred financing costs and original issue discount between the Term Loan and the DD TL on July 2, 2020 was as follows (amounts in thousands): July 2, 2020 Term Loan DD TL Total Long term debt Other current assets Original issue discount $ 333 $ 167 $ 500 Deferred financing costs 2,169 1,084 3,253
Schedule of Debt	The balances of the Term Loan as of March 31, 2021 and December 31, 2020 were as follows (amounts in thousands): March 31, 2021 December 31, 2020 Outstanding principal $ 50,000 $ 50,000 Deferred financing costs (1,908) (1,996) Original issue discount (293) (307) Long term debt $ 47,799 $ 47,697
Schedule of Interest Expense	Interest expense related to the Term Loan, included in interest expense, net in the unaudited condensed consolidated statements of operations, was as follows (amounts in thousands): Three Months Ended March 31, 2021 Stated interest $ 1,031 Amortization of deferred financing costs 89 Accretion of original issue discount 13 Interest expense $ 1,133 Interest expense related to the DD TL, included in interest expense, net in the unaudited condensed consolidated statements of operations, was as follows (amounts in thousands): Three Months Ended March 31, 2021 Commitment fee $ 63 Amortization of deferred financing costs 271 Accretion of original issue discount 41 Interest expense $ 375 Interest expense related to the BT Term Loan, included in interest expense, net in the unaudited condensed consolidated statements of operations was as follows (amounts in thousands): Three Months Ended March 31, 2020 Interest on principal balance $ 1,840 Accretion of original issue discount 167 Amortization of deferred financing costs 491 Total BT Term Loan interest expense $ 2,498
Future Principal Payments for the Term Loan	Principal payments on the Term Loan as of March 31, 2021 are as follows: Year ending December 31, Principal 2021 (excluding the three months ended March 31, 2021) $ — 2022 — 2023 — 2024 — 2025 50,000 Thereafter — Total long term debt $ 50,000

Net Loss Per Common Share (Tabl

Net Loss Per Common Share (Tables)	3 Months Ended
	Mar. 31, 2021
Earnings Per Share [Abstract]
Schedule of Earnings Per Share, Basic	The following table provides a reconciliation of net loss to net loss available to common stockholders and calculation of basic net loss per common share for each of the three months ended March 31, 2021 and 2020 (amounts in thousands, except share and per share amounts): Three Months Ended March 31, 2021 2020 Net loss $ (8,382) $ (4,821) Adjustments to reconcile to net (loss) income available to common stockholders Accumulated dividend on Series B Convertible Preferred Stock 1,006 — Accretion of increasing-rate dividend feature 462 — Total adjustments 1,468 — Net loss available to common stockholders $ (9,850) $ (4,821) Weighted average common shares outstanding 109,401,383 107,538,509 Basic net loss per common share $ (0.09) $ (0.04)
Schedule of Earnings Per Share, Diluted	The following table sets forth the computation of diluted net loss per common share (in thousands, except share and per share amounts): Three Months Ended March 31, 2021 2020 Net loss available to common stockholders $ (9,850) $ (4,821) Dividends on Series B Convertible Preferred Stock 1,468 — Numerator $ (9,850) $ (4,821) Weighted average shares outstanding 109,401,383 107,538,509 Potential common shares (a) 30,470,089 2,706,804 Weighted average shares outstanding adjusted for potential common shares 109,401,383 107,538,509 Diluted net loss per common share $ (0.09) $ (0.04) (a) Potential common shares reflects hypothetical transactions involving convertible securities and share-based payment awards using the if-converted and treasury stock methods, respectively. The effect of each of these adjustments on the calculation is presented in the table below: Three Months Ended March 31, 2021 2020 Series B Convertible Preferred Stock 26,497,570 — Restricted stock awards 1,629,273 1,769,847 Restricted Stock Unit Awards 1,349,898 — Outstanding Stock Options 964,640 919,555 Performance Based Awards 28,708 17,402 Potential common shares 30,470,089 2,706,804

Equity Equity (Tables)

Equity Equity (Tables)	3 Months Ended
	Mar. 31, 2021
Equity [Abstract]
Schedule of Series B Preferred Stock	The below table illustrates changes in the Company’s balance of Series B Preferred Stock for the three months ended March 31, 2021 (in thousands, except share amounts): Series B Preferred Stock Shares Amount Balance at December 31, 2020 100,000 $ 91,568 Deemed dividends — 462 Balance at March 31, 2021 100,000 $ 92,030

Supplemental Disclosure of Ca_2

Supplemental Disclosure of Cash Flow and Non-Cash Investing and Financing Activities (Tables)	3 Months Ended
	Mar. 31, 2021
Supplemental Cash Flow Elements [Abstract]
Supplemental Disclosure of Cash Flow and Non-cash Investing and Financing Activities	Selected cash payments, receipts, and non-cash activities are as follows (in thousands): Three Months Ended March 31, 2021 2020 Cash paid for interest $ 1,094 $ 1,840 Income taxes paid 4 6 Non-cash activities: Lease right of use asset and liability 189 — Note receivable for sale of property and equipment 75 — Purchases of equipment in accounts payable 159 — Fair value of non-cash consideration received for option exercise 380 — Deemed dividends on Series B Convertible Preferred Stock 462 —

Revenue Data by Customer Type (

Revenue Data by Customer Type (Tables)	3 Months Ended
	Mar. 31, 2021
Segment Reporting [Abstract]
Summary of Net Sales by Customer Type	Below is a summary of net sales by each customer type (in thousands): Three Months Ended March 31, 2021 2020 Direct Customers $ 57,555 59,896 Distributors 2,412 1,840 Total $ 59,967 $ 61,736

Share-based Compensation (Table

Share-based Compensation (Tables)	3 Months Ended
	Mar. 31, 2021
Share-based Payment Arrangement [Abstract]
Summary of Restricted Stock Awards by Award Type	The below table summarizes activity of unvested restricted stock awards by award type from January 1, 2021 through March 31, 2021. Unvested RSA awards noted below are included in issued and outstanding common stock as of March 31, 2021, while unvested RSUs and PSUs are not included in issued or outstanding common stock as of March 31, 2021. RSA RSU PSU Number of Weighted-Average Grant Date Number of Weighted-Average Grant Date Number of Weighted-Average Grant Date Unvested at January 1, 2021 2,175,859 $ 4.78 2,325,273 $ 5.90 35,212 $ 7.10 Granted — — 2,818,085 10.07 — — Vested (222,741) 8.60 (742,001) 5.90 — — Forfeited (35,589) 3.76 (32,856) 5.90 — — Unvested at March 31, 2021 1,917,529 $ 4.36 4,368,501 $ 8.59 35,212 $ 7.10
Summary of Stock Options Activity	A summary of stock option activity for the three months ended March 31, 2021 is presented below: Number of Weighted- Weighted- Aggregate Outstanding at January 1, 2021 2,025,683 $ 4.62 Granted — — Exercised (352,623) 3.67 Unvested options forfeited (50,000) 1.23 Vested options expired — — Outstanding at March 31, 2021 1,623,060 4.93 2.16 8,714,632 Exercisable at March 31, 2021 1,623,060 $ 4.93 2.16 $ 8,714,632

Nature of Business (Details)

Nature of Business (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020	Dec. 31, 2020
Unusual or Infrequent Item, or Both [Line Items]
Income tax provision (expense) benefit	$ (58)	$ 11,304
Income tax receivable	9,991		$ 10,045
CARES Act
Unusual or Infrequent Item, or Both [Line Items]
Income tax provision (expense) benefit	11,300
Federal tax refund	1,200
Income tax receivable	$ 10,100

Significant Accounting Polici_4

Significant Accounting Policies - Narrative (Details)	3 Months Ended			12 Months Ended
	Mar. 31, 2021USD ($)reportingUnit	Mar. 31, 2020USD ($)	Mar. 31, 2019USD ($)	Dec. 31, 2020USD ($)
Finite-Lived Intangible Assets [Line Items]
Allowance for doubtful accounts	$ (700,000)			$ (700,000)
Number of reporting units | reportingUnit	1
Goodwill impairment			$ 0
Group purchasing organization administrative fees (as a percent)	3.00%
Deferred cost of sales	$ 100,000			$ 200,000
Capitalized patent costs	$ 200,000	$ 100,000
Minimum
Finite-Lived Intangible Assets [Line Items]
Typical payment period for customers				30 days
Maximum
Finite-Lived Intangible Assets [Line Items]
Typical payment period for customers				60 days

Significant Accounting Polici_5

Significant Accounting Policies - Assessment of Revenue under ASC 606 (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Revenue, Initial Application Period Cumulative Effect Transition [Line Items]
Net sales	$ 59,967	$ 61,736
Cost of sales	9,641	10,025
Gross Profit	50,326	51,711
Accounting Standards Update 2014-09
Revenue, Initial Application Period Cumulative Effect Transition [Line Items]
Net sales	298	4,495
Cost of sales	42	629
Gross Profit	$ 256	$ 3,866

Inventory (Details)

Inventory (Details) - USD ($) $ in Thousands	Mar. 31, 2021	Dec. 31, 2020
Inventory Disclosure [Abstract]
Raw materials	$ 477	$ 314
Work in process	6,226	4,316
Finished goods	4,879	5,731
Inventory	$ 11,582	$ 10,361

Property and Equipment - Summar

Property and Equipment - Summary of Property and Equipment (Details) - USD ($) $ in Thousands	Mar. 31, 2021	Dec. 31, 2020
Property, Plant and Equipment [Line Items]
Property and equipment, gross	$ 41,089	$ 40,935
Less accumulated depreciation	(30,045)	(29,498)
Property and equipment, net	11,044	11,437
Leasehold improvements
Property, Plant and Equipment [Line Items]
Property and equipment, gross	6,010	6,010
Laboratory and clean room equipment
Property, Plant and Equipment [Line Items]
Property and equipment, gross	14,828	15,524
Furniture and equipment
Property, Plant and Equipment [Line Items]
Property and equipment, gross	15,137	15,295
Construction in progress
Property, Plant and Equipment [Line Items]
Property and equipment, gross	4,295	3,321
Asset retirement cost
Property, Plant and Equipment [Line Items]
Property and equipment, gross	$ 819	$ 785

Property and Equipment - Deprec

Property and Equipment - Depreciation Expense (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Property, Plant and Equipment [Abstract]
Depreciation expense	$ 1,161	$ 1,506

Leases - Narrative (Details)

Leases - Narrative (Details) $ in Millions	3 Months Ended
	Mar. 31, 2021USD ($)warehouseSpace
Leases [Abstract]
Number of subleased warehouse spaces | warehouseSpace	1
Sublet income | $	$ 0.1

Leases - Lease Costs (Details)

Leases - Lease Costs (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Leases [Abstract]
Operating lease cost	$ 335	$ 350
Amortization of leased assets	237	239
Depreciation expense on finance lease	8	0
Interest expense on finance lease	$ 3	$ 0

Leases - Supplemental Balance S

Leases - Supplemental Balance Sheet Information (Details) - USD ($) $ in Thousands	Mar. 31, 2021	Dec. 31, 2020
Operating Leases
Right of use asset	$ 3,386	$ 3,623
Current right of use liability	1,210	1,176
Noncurrent right of use liability	2,637	2,960
Right of use liability	$ 3,847	$ 4,136
Weighted-average remaining lease term (years)	4 years 2 months 12 days	4 years 4 months 24 days
Weighted-average discount rate	10.00%	10.00%
Finance Leases
Right of use asset	$ 181	$ 0
Current right of use liability	42	0
Noncurrent right of use liability	140	0
Right of use liability	$ 182	$ 0
Weighted-average remaining lease term (years)	3 years 9 months 18 days	0 years
Weighted-average discount rate	8.30%	0.00%

Leases - Maturity of Lease Liab

Leases - Maturity of Lease Liabilities (Details) - USD ($) $ in Thousands	Mar. 31, 2021	Dec. 31, 2020
Operating Leases
2021 (excluding the three months ended March 31, 2021)	$ 1,151
2022	1,566
2023	507
2024	339
2025	339
2026	339
Thereafter	365
Total lease payments	4,606
Less: imputed interest	(759)
Right of use liability	3,847	$ 4,136
Finance Leases
2021 (excluding the three months ended March 31, 2021)	41
2022	55
2023	55
2024	55
2025	5
2026	0
Thereafter	0
Total lease payments	211
Less: imputed interest	(29)
Right of use liability	182	$ 0
2021 (excluding the three months ended March 31, 2021)	1,192
2022	1,621
2023	562
2024	394
2025	344
2026	339
Thereafter	365
Total lease payments	4,817
Less: imputed interest	(788)
Present value of lease liabilities	$ 4,029

Intangible Assets - Activity Su

Intangible Assets - Activity Summary (Details) - USD ($) $ in Thousands	Mar. 31, 2021	Dec. 31, 2020
Finite-Lived Intangible Assets [Line Items]
Gross carrying amount	$ 11,291	$ 11,285
Accumulated amortization	(7,549)	(7,334)
Net carrying amount	3,742	3,951
Indefinite-lived Intangible Assets [Line Items]
Intangible assets, gross carrying amount	13,467	13,338
Intangible assets, net carrying amount	5,918	6,004
Trade names and trademarks
Indefinite-lived Intangible Assets [Line Items]
Gross carrying value, indefinite lived	1,008	1,008
Patents in process
Indefinite-lived Intangible Assets [Line Items]
Gross carrying value, indefinite lived	1,168	1,045
Patents and know how
Finite-Lived Intangible Assets [Line Items]
Gross carrying amount	9,516	9,510
Accumulated amortization	(5,899)	(5,730)
Net carrying amount	3,617	3,780
Licenses
Finite-Lived Intangible Assets [Line Items]
Gross carrying amount	1,414	1,414
Accumulated amortization	(1,369)	(1,334)
Net carrying amount	45	80
Customer and supplier relationships
Finite-Lived Intangible Assets [Line Items]
Gross carrying amount	241	241
Accumulated amortization	(176)	(172)
Net carrying amount	65	69
Non-compete agreements
Finite-Lived Intangible Assets [Line Items]
Gross carrying amount	120	120
Accumulated amortization	(105)	(98)
Net carrying amount	$ 15	$ 22

Intangible Assets - Amortizatio

Intangible Assets - Amortization Expense (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Goodwill and Intangible Assets Disclosure [Abstract]
Amortization expense	$ 239	$ 271

Intangible Assets - Estimated F

Intangible Assets - Estimated Future Amortization Expense for Intangible Assets (Details) - USD ($) $ in Thousands	Mar. 31, 2021	Dec. 31, 2020
Estimated future amortization expense [Abstract]
2021 (excluding the three months ended March 31, 2021)	$ 579
2022	692
2023	692
2024	692
2025	280
Thereafter	807
Net carrying amount	$ 3,742	$ 3,951

Accrued Expenses (Details)

Accrued Expenses (Details) - USD ($) $ in Thousands	Mar. 31, 2021	Dec. 31, 2020
Payables and Accruals [Abstract]
Legal costs	$ 18,812	$ 14,822
Settlement costs	6,850	9,975
Estimated returns	498	688
Commissions to sales agents	2,153	2,141
Accrued clinical trials	610	651
Accrued rebates	377	886
Other	1,376	1,297
Total	$ 30,676	$ 30,460

Long Term Debt - Term Loan (Det

Long Term Debt - Term Loan (Details) - Term loan

Jul. 02, 2020USD ($)

Apr. 22, 2020USD ($)

Jun. 10, 2019USD ($)

Mar. 31, 2021USD ($)

Jun. 30, 2022

Jun. 30, 2021

Jul. 02, 2023

Jul. 02, 2022

Jul. 02, 2021

Jul. 02, 2025

Jul. 02, 2025

Dec. 31, 2020USD ($)

Hayfin Loan Agreement Term Loan

Debt Instrument [Line Items]

Principal issued

$ 50,000,000

Original issue discount

$ 293,000

$ 307,000

Hayfin Loan Agreement Term Loan | London Interbank Offered Rate (LIBOR)

Debt Instrument [Line Items]

Debt instrument, interest rate, floor (percent)

1.50%

Debt instrument, basis spread on variable rate

6.75%

Default interest rate (percent)

3.00%

Interest rate at issuance (percent)

8.30%

Financing Transactions

Debt Instrument [Line Items]

Principal issued

$ 100,000,000

Credit Facilities

Debt Instrument [Line Items]

Debt covenant, minimum liquidity

10,000,000

Original issue discount

500,000

Deferred financing costs

$ 3,253,000

Hayfin Loan Agreement Delayed Draw Term Loan

Debt Instrument [Line Items]

Additional commitment fee (percent)

1.00%

BT Term Loan

Debt Instrument [Line Items]

Principal issued

$ 75,000,000

Fair value of the Term Loan

$ 51,400,000

Quarterly installments

900,000

Original issue discount

2,300,000

Deferred financing costs

$ 6,700,000

Amended Term Loan Agreement

Debt Instrument [Line Items]

Deferred financing costs

$ 700,000

Amended Term Loan Agreement | London Interbank Offered Rate (LIBOR)

Debt Instrument [Line Items]

Debt instrument, basis spread on variable rate

9.00%

Increase in interest rate (percent)

1.00%

Forecast | Hayfin Loan Agreement Term Loan, Total Net Leverage Ratio Less than 2.0x but Greater than or Equal to 1.0x | London Interbank Offered Rate (LIBOR)

Debt Instrument [Line Items]

Debt instrument, basis spread on variable rate

6.50%

Forecast | Hayfin Loan Agreement Term Loan, Total Net Leverage Ratio Less than 1.0x | London Interbank Offered Rate (LIBOR)

Debt Instrument [Line Items]

Debt instrument, basis spread on variable rate

6.00%

Total net leverage ratio

1

Forecast | Credit Facilities

Debt Instrument [Line Items]

Total net leverage ratio

4

Debt instrument, prepayment make-whole premium as percent of prepaid principal (percent)

1.00%

2.00%

5.00%

0.00%

Debt instrument, prepayment make-whole premium as percent of prepaid principal, plus accrued interest (percent)

102.00%

Forecast | Credit Facilities | Subsequent Event

Debt Instrument [Line Items]

Total net leverage ratio

4.5

Minimum | Hayfin Loan Agreement Term Loan | Prime Rate

Debt Instrument [Line Items]

Debt instrument, basis spread on variable rate

0.50%

Minimum | Forecast | Hayfin Loan Agreement Term Loan, Total Net Leverage Ratio Less than 2.0x but Greater than or Equal to 1.0x | London Interbank Offered Rate (LIBOR)

Debt Instrument [Line Items]

Total net leverage ratio

1

Maximum | Hayfin Loan Agreement Term Loan | Fed Funds Effective Rate Overnight Index Swap Rate

Debt Instrument [Line Items]

Debt instrument, basis spread on variable rate

2.50%

Maximum | Forecast | Hayfin Loan Agreement Term Loan, Total Net Leverage Ratio Less than 2.0x but Greater than or Equal to 1.0x | London Interbank Offered Rate (LIBOR)

Debt Instrument [Line Items]

Total net leverage ratio

2

Long Term Debt - Term Loan Debt

Long Term Debt - Term Loan Debt Issuance Costs (Details) - Term loan - USD ($) $ in Thousands	Mar. 31, 2021	Dec. 31, 2020	Jul. 02, 2020
Credit Facilities
Debt Instrument [Line Items]
Original issue discount			$ 500
Deferred financing costs			3,253
Hayfin Loan Agreement Term Loan
Debt Instrument [Line Items]
Original issue discount	$ 293	$ 307
Long term debt | Hayfin Loan Agreement Term Loan
Debt Instrument [Line Items]
Original issue discount			333
Deferred financing costs			2,169
Other current assets | Hayfin Loan Agreement Delayed Draw Term Loan
Debt Instrument [Line Items]
Original issue discount			167
Deferred financing costs			$ 1,084

Long Term Debt - Term Loan Bala

Long Term Debt - Term Loan Balances (Details) - USD ($) $ in Thousands	Mar. 31, 2021	Dec. 31, 2020
Debt Instrument [Line Items]
Long term debt	$ 50,000
Term loan | Hayfin Loan Agreement Term Loan
Debt Instrument [Line Items]
Outstanding principal	50,000	$ 50,000
Deferred financing costs	(1,908)	(1,996)
Original issue discount	(293)	(307)
Long term debt	$ 47,799	$ 47,697

Long Term Debt - Term Loan Inte

Long Term Debt - Term Loan Interest Expense (Details) - Term loan - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Hayfin Loan Agreement Term Loan
Debt Instrument [Line Items]
Interest on principal balance	$ 1,031
Accretion of original issue discount	13
Amortization of deferred financing costs	89
Total BT Term Loan interest expense	1,133
Hayfin Loan Agreement Delayed Draw Term Loan
Debt Instrument [Line Items]
Commitment fee	63
Accretion of original issue discount	41
Amortization of deferred financing costs	271
Total BT Term Loan interest expense	$ 375
BT Term Loan
Debt Instrument [Line Items]
Interest on principal balance		$ 1,840
Accretion of original issue discount		167
Amortization of deferred financing costs		491
Total BT Term Loan interest expense		$ 2,498

Long Term Debt - Term Loan Matu

Long Term Debt - Term Loan Maturity (Details) $ in Thousands	Mar. 31, 2021USD ($)
Debt Disclosure [Abstract]
2021 (excluding the three months ended March 31, 2021)	$ 0
2022	0
2023	0
2024	0
2025	50,000
Thereafter	0
Long term debt	$ 50,000

Net Loss Per Common Share - Bas

Net Loss Per Common Share - Basic Net Loss Per Common Share (Details) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Earnings Per Share [Abstract]
Net loss	$ (8,382)	$ (4,821)
Adjustments to reconcile to net (loss) income available to common stockholders
Accumulated dividend on Series B Convertible Preferred Stock	1,006	0
Accretion of increasing-rate dividend feature	462	0
Total adjustments	1,468	0
Net loss available to common stockholders	$ (9,850)	$ (4,821)
Weighted average common shares outstanding - basic (in shares)	109,401,383	107,538,509
Basic net loss per common share (in dollars per share)	$ (0.09)	$ (0.04)

Net Loss Per Common Share - Dil

Net Loss Per Common Share - Diluted Net Loss Per Common Share (Details) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Computation of basic and diluted net loss per share [Abstract]
Net loss available to common stockholders	$ (9,850)	$ (4,821)
Dividends on Series B Convertible Preferred Stock	$ 1,468	$ 0
Weighted average shares outstanding (in shares)	109,401,383	107,538,509
Weighted average shares outstanding adjusted for potential common shares	109,401,383	107,538,509
Diluted net (loss) income per common share (in dollars per share)	$ (0.09)	$ (0.04)
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive securities excluded from computation of earnings per share (in shares)	30,470,089	2,706,804
Series B Convertible Preferred Stock
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive securities excluded from computation of earnings per share (in shares)	26,497,570	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)	1,629,273	1,769,847
Restricted Stock Unit Awards
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive securities excluded from computation of earnings per share (in shares)	1,349,898	0
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)	964,640	919,555
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)	28,708	17,402

Equity - Narrative (Details)

Equity - Narrative (Details)	Jul. 02, 2020USD ($)daydirector$ / shares	Mar. 31, 2021USD ($)$ / sharesshares	Mar. 31, 2020USD ($)	Dec. 31, 2020$ / shares
Dividends Payable [Line Items]
Series B convertible preferred stock par value (in dollars per share) | $ / shares		$ 0.001		$ 0.001
Deemed dividends		$ (462,000)
Series B Preferred convertible Stock, dividends accrued but not recorded for the period		1,006,000	$ 0
Preferred Class B Convertible Stock
Dividends Payable [Line Items]
Issuance of Series B Preferred Stock	$ 100,000,000
Series B convertible preferred stock par value (in dollars per share) | $ / shares	$ 0.001
Proceeds from issuance of temporary equity	$ 100,000,000
Series B preferred stock, conversion price (in dollars per share) | $ / shares	$ 3.85
Conversion ratio of Series B preferred stock to common stock	259.74
Series B preferred stock, minimum percentage of conversion stock price to trigger conversion (percent)	200.00%
Number of trading days within consecutive day trading period common stock must exceed trigger conversion price | day	20
Series B preferred stock, threshold number of consecutive trading days | day	30
Series B preferred stock, minimum percentage of conversion stock price on conversion date (percent)	200.00%
Number of board seats elected by Series B preferred stockholders | director	2
Series B preferred stock, maximum voting stock percentage on an as-converted basis (percent)	19.90%
Series B preferred stock, increasing-rate dividend feature	$ 1,800,000
Series B Preferred convertible Stock, dividends accrued but not recorded for the period		$ 3,000,000
Series B Preferred convertible stock, shares issuable upon conversion (in shares) | shares		26,758,916
Preferred Class B Convertible Stock | Discounted Dividend Rate prior to Quarterly Dividend Payment ending on June 30,2021
Dividends Payable [Line Items]
Series B convertible stock, cumulative dividend (percent)	4.00%
Preferred Class B Convertible Stock | Perpetual Dividend Rate after Quarterly Dividend Payment ending on June 30, 2021
Dividends Payable [Line Items]
Series B convertible stock, cumulative dividend (percent)	6.00%
Series B Convertible Preferred Stock
Dividends Payable [Line Items]
Deemed dividends		$ (462,000)

Equity - Changes in Series B Pr

Equity - Changes in Series B Preferred Stock (Details) $ in Thousands	3 Months Ended
	Mar. 31, 2021USD ($)shares
Increase (Decrease) in Temporary Equity [Roll Forward]
Series B Preferred Stock, outstanding, beginning (in shares) | shares	100,000
Series B Preferred Stock, outstanding, ending (in shares) | shares	100,000
Series B Preferred Stock, outstanding, beginning	$ 91,568
Deemed dividends	462
Series B Preferred Stock, outstanding, ending	$ 92,030
Series B Convertible Preferred Stock
Increase (Decrease) in Temporary Equity [Roll Forward]
Series B Preferred Stock, outstanding, beginning (in shares) | shares	100,000
Series B Preferred Stock, outstanding, ending (in shares) | shares	100,000
Series B Preferred Stock, outstanding, beginning	$ 91,568
Deemed dividends	462
Series B Preferred Stock, outstanding, ending	$ 92,030

Income taxes (Details)

Income taxes (Details) - USD ($)	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Income Tax Disclosure [Abstract]
Effective tax rate	(0.70%)	70.10%
Effective income tax rate impact of discrete items	$ 0	$ 11,400,000
Unusual or Infrequent Item, or Both [Line Items]
Income tax provision (expense) benefit	(58,000)	$ 11,304,000
Tax benefit recognized with respect to net operating loss	0
CARES Act
Unusual or Infrequent Item, or Both [Line Items]
Income tax provision (expense) benefit	$ 11,300,000

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, 2021	Mar. 31, 2020
Supplemental Cash Flow Elements [Abstract]
Cash paid for interest	$ 1,094	$ 1,840
Income taxes paid	4	6
Non-cash activities:
Lease right of use asset and liability	189	0
Note receivable for sale of property and equipment	75	0
Purchases of equipment in accounts payable	159	0
Fair value of non-cash consideration received for option exercise	380	0
Deemed dividends on Series B Convertible Preferred Stock	$ 462	$ 0

Contractual Commitments and C_2

Contractual Commitments and Contingencies - Narrative (Details) $ in Millions	Jun. 03, 2020healthcareProvider	Jan. 09, 2020formerClinician	Jan. 21, 2019formerEmployee	Jan. 16, 2019securityClassAction	Mar. 31, 2021USD ($)
Commitments and Contingencies Disclosure [Abstract]
Lessee expiration period (in years)					3 years
Litigation liability					$ 6.9
Settlements indemnified by insurance					0.7
Payments for legal settlements					$ 4.4
Number of securities class actions | securityClassAction				2
Number of healthcare providers | healthcareProvider	2
Number of gormer clinicans | formerClinician		2
Number of former employees | formerEmployee			3

Revenue Data by Customer Type_2

Revenue Data by Customer Type (Details) $ in Thousands	3 Months Ended
	Mar. 31, 2021USD ($)distributionChannel	Mar. 31, 2020USD ($)
Revenue, Major Customer [Line Items]
Number of primary distribution channels | distributionChannel	2
Net sales	$ 59,967	$ 61,736
Direct Customers
Revenue, Major Customer [Line Items]
Net sales	57,555	59,896
Distributors
Revenue, Major Customer [Line Items]
Net sales	$ 2,412	$ 1,840

Share-based Compensation - Narr

Share-based Compensation - Narrative (Details) $ in Millions	3 Months Ended
	Mar. 31, 2021USD ($)
Share-based Payment Arrangement [Abstract]
Total unrecognized compensation expense	$ 36.3
Outstanding Options, weighted average remaining contractual term (in years)	2 years 8 months 1 day

Share-based Compensation - Rest

Share-based Compensation - Restricted Stock Awards (Details) - $ / shares	3 Months Ended
	Mar. 31, 2021	Dec. 31, 2020
Restricted stock awards
Number of Shares
Unvested, Beginning Balance (in shares)	2,175,859
Granted (in shares)	0
Vested (in shares)	(222,741)
Forfeited (in shares)	(35,589)
Unvested, Ending Balance (in shares)	1,917,529
Weighted-Average Grant Date Fair Value
Unvested, Beginning Balance (in dollars per share)	$ 4.36	$ 4.78
Granted (in dollars per share)	0
Vested (in dollars per share)	8.60
Forfeited (in dollars per share)	3.76
Unvested, Ending Balance (in dollars per share)	$ 4.36
Restricted Stock Unit Awards
Number of Shares
Unvested, Beginning Balance (in shares)	2,325,273
Granted (in shares)	2,818,085
Vested (in shares)	(742,001)
Forfeited (in shares)	(32,856)
Unvested, Ending Balance (in shares)	4,368,501
Weighted-Average Grant Date Fair Value
Unvested, Beginning Balance (in dollars per share)	$ 8.59	5.90
Granted (in dollars per share)	10.07
Vested (in dollars per share)	5.90
Forfeited (in dollars per share)	5.90
Unvested, Ending Balance (in dollars per share)	$ 8.59
Performance Based Awards
Number of Shares
Unvested, Beginning Balance (in shares)	35,212
Granted (in shares)	0
Vested (in shares)	0
Forfeited (in shares)	0
Unvested, Ending Balance (in shares)	35,212
Weighted-Average Grant Date Fair Value
Unvested, Beginning Balance (in dollars per share)	$ 7.10	$ 7.10
Granted (in dollars per share)	0
Vested (in dollars per share)	0
Forfeited (in dollars per share)	0
Unvested, Ending Balance (in dollars per share)	$ 7.10

Share-based Compensation - Stoc

Share-based Compensation - Stock Incentive Plans (Details)	3 Months Ended
	Mar. 31, 2021USD ($)$ / sharesshares
Number of Shares
Outstanding, beginning of period (in shares) | shares	2,025,683
Granted (in shares) | shares	0
Exercised (in shares) | shares	(352,623)
Unvested options forfeited (in shares) | shares	(50,000)
Vested options expired (in shares) | shares	0
Outstanding, end of period (in shares) | shares	1,623,060
Exercisable options, vested and expected to vest (in shares) | shares	1,623,060
Weighted- Average Exercise Price
Outstanding, beginning of period (in dollars per share) | $ / shares	$ 4.62
Granted (in dollars per share) | $ / shares	0
Exercised (in dollars per share) | $ / shares	3.67
Unvested options forfeited (in dollars per share) | $ / shares	1.23
Vested options expired (in dollars per share) | $ / shares	0
Outstanding, end of period (in dollars per share) | $ / shares	4.93
Exercisable (in dollars per share) | $ / shares	$ 4.93
Weighted- Average Remaining Contractual Term (in years)
Outstanding (in years)	2 years 1 month 28 days
Exercisable (in years)	2 years 1 month 28 days
Aggregate Intrinsic Value
Outstanding | $	$ 8,714,632
Exercisable | $	$ 8,714,632