Matthew J OToole MD, CPC

Matthew J OToole MD, CPC

South Florida Utilization Review

Chicago , IL 60654
Mobile: 630-740-5592

I am a board certified internal medicine physician actively practicing hospital medicine. I am also an AAPC Certified Professional Coder (CPC). I have extensive experience auditing ICD-10, CPT, and HCPCS level II coding. I have reviewed and negotiated over 1,000 medical bills on behalf of worker's compensation payers on the basis of coding accuracy, fee schedule amounts, UCR (Usual, Customary, and Reasonable) rates, and medical necessity. I have considerable expertise in clinical documentation integrity and have performed over 450 DRG clinical validation audits.

Areas of Expertise
  • Auditing
  • Hospitalist Medicine
  • Independent Medical Examinations
  • Insurance Fraud
  • Internal Medicine
  • Medical Billing
  • Medical Fraud
  • Medical Insurance
  • Medical Records
  • Workers Compensation Insurance

Expert Background
Q: Please list your professional accreditations, degrees, licenses, and certificates granted:
A: Doctor of Medicine (MD) Loyola University of Chicago Stritch School of Medicine
Completed Residency in Internal Medicine at University of Illinois at Chicago
Board Certified in Internal Medicine
Certified Professional Coder (CPC)
Milliman Care Guidelines (MCG) Certified Specialist in Utilization Management
Q: Please list your affiliations or memberships in any professional and/or industry organizations:
A: American Academy of Professional Coders (AAPC)
American Board of Internal Medicine (ABIM)
Q: Have any of your accreditations ever been investigated, suspended or removed? (if yes, explain)
A: No
Q: On how many occasions have you been retained as an expert?
A: 1
Q: For what area(s) of expertise have you been retained as an expert?
A: Coding accuracy, clinical documentation integrity
Q: What services do you offer? (E.g.: consulting, testing, reports, site inspections etc.)
A: Consulting
Medical Record Review
Expert Witness


Available Upon Request