I used to judge pretty regularly in living campaigns and the same mod for different tables could have greatly different outcomes. For tough groups I would focus fire on the squishiest character first (depending on options/weaknesses) and for weaker groups I'd spread out damage and so on.
I think some of the simplest suggestions on this thread that other people have pointed out for published adventures to make them more difficult
- Add +n to attack modifiers (in most cases even a +2 from an averaged off-screen Bless spell would be enough).
- Increase damage. An easy way would be to add n% or max out the variable portion of the damage. Be careful though with the big hitters like breath weapons, you don't want to accidentally TPK.
- Max out hit points of the monsters.
- Limit rest options.
- Ignore the numerical limits on number of monsters. If the mod says there are 5 ogres, make it 10. If the group wipes out all the monsters in round 1, have reinforcements drawn to the sound of battle show up in round 2 or 3. Have them show up behind the party so they attack the wizard that always hides in the back first.
- Add ambushes and traps.
Mix and match the above so you have a variety of types of fights.
I ran a city of the spider queen conversion that went to level 18.
Using the DMG rules to create monsters is really all you need to do. The DMG created monsters tend to be vastly more challenging than stock creatures in the monsters manual. My players in that game constantly commented on how hard it was.